신상아에서 후족부 모세 혈액 검사 이후에 발생한 종골 골수염

최장석,김정원 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

In neonate, osteomyelitis of the calcaneus is extremely rare and various reports have indicated that it accounts for 3~8% of all bone infections among neonates, infection can result from hematogenous seeding or direct inoculation, as seen in puncture wounds (accidental or for blood sampling), open fracture, degloving injuries. and extension of pressure ulceration. Although direct inoculation has been reported to be the more frequent cause, other reports suggest a hematogenous etiology in the majority. We compared our experience that neonate calcaneal osteomyelitis after hind foot capillary blood sampling for cogenital metabolic deficiencies test and follow up of bilirubin level at Paik Hospital, Inje University, Pusan, Korea to that reported in the literature to determine if the experience at this institution was similar to that previously reported. Additionally, characteristics of the clinical presentation, laboratory investigation, treatment, and outcome were studied to determine if any factors might be helpful in making an earlier diagnosis, improving outcome, or both.

정신간호조무사 양성소 교육과정 전후의 정신질환에 대한 태도조사

최석민,장경준 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

이 연구는 정신질환에 대한 태도 변화가 적절한 교육에 의하여 변화할 수 있다는 관점에서, 정신질환자 치료에 일익을 담당하게 정신간호조무사를 양성하는 국립서울정신병원 부설 정신 간호조무사 양성소의 학생을 대상으로 정신질환에 대한 태도 조사를 하여, 정신과 교육이 정신질환에 대한 태도에 미치는 영향을 보았다, 연구 방법은 1993년과 1994년에 양성소 교육을 받고 전과정을 수료한 39명을 대상으로, 정신질환에 대한 태도를 묻는 설문지를 사용하여 정신과 교육전, 후의 정신질환에 대한 태도의 변화를 보았으며, 그 결과는 다음과 같다. 먼저 양성소 교육이 정신질한에 대한 태도에 미친 영향을 보면 다음과 같다. 1) 정신병 환자에 대한 개념 및 태도는 긍정적인 방향으로 변하였다(p<0.05). 2) 정신병원에 입원한 환자에 대한 치료 전망, 개방병동에 대한 태도의 변화는 부정적인 방향으로 변화하였다(p<0.05). 3) 나머지 신경증에 대한 개념, 정신질환에 대한 부정적 편견, 정신질환의 치료 예후에 대한 태도, 입원치료와 가정내 보호에 대한 태도, 정신병동의 기능에 대한 태도는 통계적으로 유의한 수준의 변화가 없었다. 이 연구의 조사 대상군의 특성을 알아보기 위해 동일한 설문을 사용하여 조사한 일반인 군, 의과 대학생 군과 비교해 보면 다음과 같은 결과를 얻었다. 1) 이 연구의 교육전 대상군은 정신과 실습을 받지 않은 의과대학생군과 정신질환에 대한 태도를 묻는전체 문항에서 통계적으로 유의한 차이를 보이지 않았다. 2) 이 연구의 교육적 대상군은 일반인보다 신경증에 대한 개념, 정신질환의 치료 예후에 대한 태도, 정신병원에 입원되어 있는 환자의 치료전망에 대한 태도를 묻는 문항에서 일반인보다 부정적으로 대답하였다. Objective : This study was designed to evaluate the effect of the psychiatric nursing assistant education done at Seoul National Psychiatric Assistant School on the attitude toward mental illness. Methods : The subjects were 39 graduates from Seoul National Psychiatric Assistant School, during 1993- 1994. They were assessed during pre- and post-education periods with Scale for Mental Health Attitude(Star 1952). Chi-square test was used for statistical analysis. Results : 1) Statistically significant changes were shown in concepts and attitudes toward mentally ill patients, therapeutic prospect to inpatient, and attitude toward open ward (p<0.05). 2) Statistically significant changes were not shown in concepts of neurosis, negativistic bias toward mental illness, therapeutic prognosis of mental illness, attitude toward inpatient treatment and care in home, and attitude toward function of psychiatric ward. Conclusion : We conclude that psychiatric nursing assistant education needs further improvement.

요로결석 환자에서 Pethidine, Nalbuphine, Ketorolac의 진통효과 비교

장석준,박인철,정성필,최성욱,이한식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Ureter stone cause severe flank and abdominal pain. In emergency room, these patients require rapid pain relief and diagnosis. Therefore, authors have conducted a study on the efficacy of three types of commonly used analgesics including non opioid analgesics; intramuscular ketorolac 30mg and nalbuphine 10mg was compared with pethidine 50mg in 74 patients who visited SEVERANCE hospital emergency care center with complaint of flank colicky pain from Jan1. 1996 to Mar 31. 1996. Pain was assessed before the drug administration, and then at 10min, 20min, 30min time interval after the first dose. Visual analogue scale was used to assess the pain intensity and scale was self drawn by each patient during the time of pain assessment. Additional need of rescue analgesia and adverse effecfs of first-line analgesia was also recorded. Statistical significant was confirmed using ANOVA and Chi square test. The difference in the decrease of pain intensity was not significant among the three analgesics(P=0.65). Rescue anagesia was required in 37.1% of pethidine, 42.8% of nalbuphine, 16.6% of ketorolac and totally 33.8%. The incidence of all types of adverse event of pethidine, nalbuphine and ketorolac were 14.2%, 14.2% and 5.5% in respectively. The results of this study have shown that non opioid analgesics are as effective as opioid analgesia. Therefore, non opioid analgesics can be tried first line of pain relief drug of renal coliky pain with minimal adverse effects.

단순 외상 환자에서 퇴원시 설명문이 환자의 이해도에 미치는 영향

장석준,정상원,최성욱,황태식,이한식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

The many previous publications have shown the advantages of written discharge instruction over verbal discharge instruction on the basis of comparing the functional illiteracy among emergency department patients. Therefore, authors have conducted a study on the efficacy of written discharge instruction over the verbal discharge instruction of two groups: minor laceration and sprain patients. For the purpose of this study, minor laceration is defined as less than 3 ㎝ laceration on the face or head, or less than 5 ㎝ laceration on extremities. And simple sprains were limited to the extremities. A total of 416 patients who visited Yong Dong Severance Hospital Emergency Care Center were the subject of this study during the period of 2 months from Feb. 1. to Mar. 31. 1996. The study was done prospectively, and patients who entered this study were randomly selected. Simple discharge instruction were made prior to the study and patients were given or verbally told the one of two instruction sets by the emergency medicine resident. After reading or hearing the instructions, each patient was asked to answer four specific questions about them. Statistical significance was examined by t-test and p value of 0.05 or less was considered statistically significant. Mean age for verbal and written instructed group were 26.2 and 25.6 years old. There were 262 and 154 patients in verbal and written instructed group, and the mean score was 2.24±1.20 and 3.42±0.52, respectively. The type of injury was divided into laceration and sprain. Laceration group showed mean score of 2.15±1.23, 3.32±0.51, and sprain group of 2.34±1.16, 3.59±0.50 in verbal and written instruction group, respectively. For the patient younger than 13 years old, discharge instruction was given or described to a guardian. Age less than 13 years old group showed mean score of 2.75±1.11, 3.31±0.48 and more than 13 years old group of 2.10±0.19, 3.34±0.53 in verbal and written instruction group, respectively. The result showed statistical significance between verbal and written instruction group of type of injury and age difference. For the future, simplified written discharge instruction may help and improve the patient`s understanding of the proper management of injury.

3D 온라인 슈팅 게임 개발 : "3D 포트리스"

金敬植,崔勝寬,寓昔珍,申一卿,朴勝浩,李東熙,李東建,張孝善 호서대학교 공업기술연구소 2000 工業技術硏究所論文集 Vol.19 No.-

In this paper, features and efficiencies of the 3D engine are described which has been developed through the research of 3D real time rendering techniques. And an on-line shooting game "3D Fortress" which has been developed using this 3D engine with server technologies is introduced for the techniques and methodology applied in the process of development of the game as well as the features and discussions of its implementation.

한국 성인의 요추 및 제1 천추의 형태계측학적 연구

전진욱,최장석 인제대학교 1999 仁濟醫學 Vol.20 No.1S

전산화단층촬영과 자기공명영상은 척추관협착증의 진단과 척추체유합술 및 척추경을 통한 나사못 삽입술 등 척추질환의 진단과 치료에 중요한 정보를 제공하고 있다. 저자들은 요천추의 전산화단층촬영과 자기공명영상 100예씩 총 200예를 대상으로 한국 성인의 제1 요추에서부터 제1 천추까지의 척추체, 척추과, 척추경을 조사하여 척추관협착증의 진단, 척추체유합술에 이식골의 크기와 척추경을 통한 나사못의 길이, 나사못의 굵기와 삽입각도 결정에 기본 자료로 활용하려 하였다. Magnetic resonance image(MRI) and computed tomography(CT) provided information for diagnosis of spinal stenosis, and for interbody fusion and instrumentation of transpedicular screw. The author had reviewed the 200 cases of MRI and CT scanning of spine for the measurement of vertebral body canal and pedicle from first lumbar vertebra to first sacral canal. The results were as follows. 1.Anteroposterior, transverse diameter and height of vertebral body increased steadily from first lumbar vertebrar to first sacral vertebra. 2.The narrowest transverse diameter of pedicle was seen at first lumbar vertebra (9.0mm) and the widest at the first sacral(20.4mm). 3.The widest superoinferior diameter of pedicle was seen at first lumbar vertebra (13.1mm) and the narrowest at third lumbar(11.8mm). Above data could be used in diagnosis of spinal stenosis, in decision of the size of bone graft in interbody fusion and length, diameter and insertion of angle of transpedicular screw.

급성 acetaminophen 중독의 임상적 고찰

손대곤,최성욱,장석준 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Acetaminophen-a common analgesics easily available without doctors prescription in our country-overdosed patient is one of most commonly encountered in the ED. But, acetaminophen is relatively safe drug and treatment of acetaminophen overdosage has been well established. But for the proper management of these patients, two following restrictions should be overcome. The first, serum acetaminophen level should be available immediately for proper disposition of the patients. The second one is the use of the antidote (NAC:N-acetyl cysteine, Mucomyst??) to the potentially toxic patients without delay and adequate dosage and route of administration of the NAC should be familiar to the emergency physician. Except a few hospital, serum acetaminophen level is not available in our country. This pitfall can make emergency physician delay the use of the NAC or misuse of the NAC. To overcome of this pitfall, we reviewed patients who admitted in our hospital due to acetaminophen overdosage from July 1. 1993 to June 30. 1995. Total 18 patients enrelled in our study, 4 male, mean age 25.5 years old, and mean ED presentation time after ingestion was 6.25 hours. Acetaminophen single ingestion was 14 cases and mixed ingestion was 4 cases. With the exception of the one case who ingested 3g of acetaminophen, all patients received 72 hour oral NAC as an antidote for poisoning of acetaminophen. Both NAC and MDAC(multiple dose activated charcoal) was used in 8 cases. 「Serum acetaminophen level was obtained in 12 cases」. "Three patients had showed hepatotoxicity-liver enzyme(SGOT/SGPT) level above 200 IU-recovered during hospitalization.` No fatal hepatotoxicity was noted in our study. Fourteen adjustment disorder, one personality disorder and three major depression was their final psychiatric diagnosis. Their mean hospital day was 7.2 days. In the conclusion, as the efficacy of NAC as an antidote decreases after 8 hours, treatment must be started immediately following all potentially toxic dose of acetaminophen. Administration can be stopped if the acetaminophen concentration is below the treatment line but it is important to avoid potentially fatal delay.

한국인의 항파상풍 항체 역가

구홍두,최옥경,장석준,정구영,이정운,김승호 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Inspite of immunization, TETANUS remains a disease with a high morbidity and mortality rate. Tetanus has been still occurred more frequently in developing countries where immunization programs are inadequate. In Korea, there is a routine immunuzation schedule with diphtheria, pertussis, and tetanus(DPT) vaccines at 2,4,6 month after birth at 18 month. But further prophylactic programs are not exist. Moreover, we have usually used only passive immunization, tetanus antitoxin, as a prophylactic regimen for injured patients instead of guidelines of Center for Disease Control. The purpose of this study was to assess the baseline tetanus immunity state and to suggest the proper immunization schedule and adequate prophylactic guideline for injured patients in Korea. One hundred thirty one trauma patients from emergency department of Severance hospital from September to November of 1993 were included. Antietanus antibody titers of the patients were analyzed by ELISA assay. The mean antitetanus antibody titer was 0.728 ±0.236IU/mL. The titers were diminished rapidly with age. In pediatric group(age under 15), the mean titer was 3.251 ±0.426 IU/mL and in geriatric group(age over 64), the mean titer was 0.007 ±0.002 IU/mL which was below the minimal protective antibody titer(0.01 IU/mL). While all of the pediatric patients have protective antibody titer, only 69.2% of young adults(15-39, n=65), 56.7% of adults(40-64, n=30), and 57.2% of geriatrics(>65, n=14) have protective antibody titer. Our results suggest that tetanus prophylaxis is unnecessary in the age under 14. In other age groups, however, our data strongly support the need of prophyulaxis.

한국 성인의 요추 및 제1 천추의 형태계측학적 연구

전진욱,최장석 인제대학교 1999 仁濟醫學 Vol.20 No.1

인공 해수분위기에서 저탄소강의 부식특성에 미치는 합금원소 Cr, Co 및 W의 효과

심재주,유승재,최윤석,김정구,유장용 대한금속재료학회 2003 대한금속·재료학회지 Vol.41 No.12

The aqueous corrosion characteristics of 1% Cr-steel alloyed with small amounts of Co and W, in synthetic seawater was studied by using immersion weight-loss tests, electrochemical corrosion tests (potentiodynamic test and electrochemical impedance spectroscopy (EIS) measurements) and analytical techniques. 1% Cr steels containing Co or W from 0.2 to 0.4 wt.% showed higher corrosion resistance than the 1% Cr steel in the immersion and potentiodynamic tests. EIS measurements showed that the Nyquist plot presented one time constant. Furthermore, the Co- and W-bearing steels present higher Rp values than the 1% Cr steel through all the test period. The better corrosion resistance of the Co-and W-bearing steels is attributed to protectiveness of the surface layer. The corrosion products were examined using electron probe microanalysis (EPMA) and X-ray photoelectron spectroscopy (XPS). The results of EPMA indicated that Cr was concentrated in the inner region of the rust layer, while Co and W were distributed all over the rust layer. XPS results showed that Co existed as a trivalent oxide in the rust layer and W in the rust appeared in the form of a WO₄ compound.