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.

癩의 免疫에 關한 硏究 : 癩患者의 末梢血液 T 및 B 淋巴球 測定에 關한 硏究

殷熙哲,金原錫,金洪植,金道一 大韓癩學會 1981 癩學 會誌 Vol.14 No.1

PILOMATRICOMA 치험 1례

김은철,이창우,임창준,이동근,김수남,양희창 大韓顎顔面成形再建外科學會 1990 Maxillofacial Plastic Reconstructive Surgery Vol.12 No.3

The pilomatricoma (calcifying epithelioma of Malherbe) is rare benign hard, spherical and freely movable cutaneous tumor, which was differentiated from hair cells, particulary hair cortex cells. It is usually occured as a single, asymptomatic, 0.5 cm to 3.0 cm sized, deep seated, firm nodule, covered by normal or pink skin. It arises chiefly in young people, including children, and most often in the head, neck and upper extrimites. The authers experienced a case of pilomatricoma which occured in preauricular region. This case was summarized as follows. 1. 10 years old female has suffered from hard subepidermal mass on preauricular area and she visited our out patient clinic. So we performed surgical extirpation and the excised specimen was pathologically examined. 2. Grossly the tumor measures 2.0 cm in diameter and firm, bosselated, spherical shaped which covered by a thin layer of fibrous tissue. On cut section, it shows spicular gritty surfaces, well encapsulation, interwoven and keratotic lamellae. 3. Histopathologically, the epithelial masses of the tumor are composed of two type of cells, basophilic cells and shodow cells. The basophilic cells resemble hair matrix cells which posses round or elogated, deeply basophilic nuclei and scanty cytoplasm.The shadow cells show a central, unstained shadow at the site of the lost nucleus. Gradual development of basophilic cells into shadow cells can be observed. Foci of calcification are present within the lobule of shadow cells. The stroma of the tumor shows a considerable foreign body giant cell reaction adjacent to the shadow cells. 4. No recurrence was observed until post - operative 40 months.

과민성 장증후군 환자에서 베타 아드레날린 수용체 기능의 활성도와 불안 수준

강은호,이풍렬,이준행,김현서,이종철,유범희 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.1

Selenium 부족 식이가 흰쥐 간장에 미치는 영향

김은희,이현기,양영철,차인준 인제대학교 1990 仁濟醫學 Vol.11 No.3

Se 부족에 의하여 랫트의 체중과 사료 섭취량은 감소되었으며 혈중 LDH, GOT와 간장조직의 glutathion 농도는 정상보다 증가되었다. Se 부족군의 조직학적 소견은 간세포의 공포화 변성, 간조직의 PAS 반응 저하, LDH 활성화 감소 및 ACP 활성의 증가를 나타내었으며, rER의 분절화 현상 및 감소와 mitochondria의 종창 등이 관찰되었다. The objective of this study was to determine the effect of Se-deficient diet on the weight gain, chemical changes in plasma and microstructural change of liver in rat. Rats were divided into 2 diet groups (Se-deficient diet) and control diet and sacrificed after 21days of feeding. Levees of LDB, GOT, GPT of Plasma arid glutathione of liver were determined and light microscopic and electron microscopic observation of ret liver were performed. Total weight gaits (P<0.05) and feed efficiency radio (P<0.001) were significantly lower in Se-deficient group than in control group, whereas the levels of plasma LDH (P<0.001) and GOT (P<0.05) were increased significantly in Se-deficient group. Furthermore, the levels of total glutathione (P<0.01) and reduced glutathione (P<0.001) showed significant increase in Se-deficient group. Light microscopic observations showed that cytoplasmic blooning degeneration and pyknosis of nuclei were often found around portal canal of Se-deficient group by H-E straining. PAS staining also showed weakly positive reaction around central area, whereas PAS negative reacting cells were often observed around portal canal of Se-deficient group. Histochemical staining skewed that cytochrome oxidase activity were very active in both groups, whereas LDH activity was significantly decreased arid ACPase activity was significantly increased in Se-deficient group. Electron microscopic observation showed that the number of rER were decreased and the blooning degeneration of rEr was often observed in Se-deficient group. Mitochondria with mayeline figure arid wooly density were also observed in Se-deficient group. Light microscopic observations showed that cytoplasmic blooming degeneration and pyknosis of nuclei were often found around poral canal of Se-deficient group by H-E staning. PAS staining also showed weakly positive reaction around central area, whereas PAS negative reacting cells were often observed around portal canal of Se-deficient group. Histochemical staining showed that sytochrome oxidase activity were very active in both groups, whereas LDH activity was significantly decreased and ACPase acclivity was significantly increased in Se-deficient group. Electron microscopic observation stewed that the number of rER were decreased and the blooning degeneration of rER was often observed in Se-deficient group. Mitochondria with myeline figure and wooly density were also observed in Se-deficient group.

1999년도 전남 지역내 저소득층 주민암 검사 실시에 따른 암유병률 조사연구

선승철,박준영,장판기,이영춘,이은희 한국건강관리협회 2000 건협 Report Vol.3 No.-

치수유래 구심성 신경섬유의 삼차신경 감각핵군에서의 연접특성

배용철,이은희,최민기,홍수형,김현정,남순현,김영진 대한소아치과학회 2001 大韓小兒齒科學會誌 Vol.28 No.2

일차연접부위에서 악안면 영역에서 유래하는 유해자극의 전달 및 처리기전을 이해하고자 horseradish pe개xidase를 치수지배 구심성 신경섬유를 표식한 후 연수후각에서 미세구조 및 연절 양상을 분석하여 다음과 같은 결과를 얻었다. 표식종말은 소수의 큰 치밀소포가 관찰되는 종말 (S형) 및 다수의 치밀소포를 함유하는 종말 (LDCV형)등 2종류로 분류할 수 있었다. S형 및 LDCV형 표식종말의 연접양식은 유사하였으며, 다수의 표식종말이 1개 혹은 2개의 neurofile과 연접을 이루어 대단히 단순한 연접양상을 보였다. 표식종말은 가지돌기체 보다는 다수의 가지돌기가시와 연접을 이루는 빈도가 높았다. 표식종말이 세포체 및 이에 인접한 근심부 가지돌기와 연접하는 경우는 드물었으며, 소수의 표식종말에서 p-ending과 연접하는 경우를 보였다. 표식종말의 체적, 표면적, 사립체의 체적, neurofile과 접하는 면적, 활성부위의 면적, 단위표식종말당 연접소포의 수 및 연접소포의 밀도등은 넓은 범위의 계측치를 나타내었으며, 이는 5명 및 LDCV형 표식종말 사이에 유의한 차이가 없었다. 이상의 결과로 미루어보아 연수후각에서 치수유래 구심성 신경섬유 종말의 연접양식은 고유의 특징을 보이며 이는 신경회로의 기능과 밀접한 상관관계를 가지는 것으로 판단되었다. Little is known about processing mechanism of pain sensation of the oral cavity at the 1st synapse of trigeminal sensory nuclei. Serial ultrathin sections of tooth pulp afferent terminals, identified by the transganglionic transport of 1% wheatgerm agglutinin conjugated horseradish peroxidase, were investigated wih electron microscope. Quantitative ultrastructural analysis was performed on digitizing tablet connected to Macintoshi personal computer (software: NIH Image 1.60, NIH, Bethesda, MD). Labeled boutons could be classified into two types by the shapes of containing vesicles : S bouton which contained mainly spherical vesicles (Dia. 45-55 nm) and few large dense cored vesicles (Dia. 80-120nm), and LDCV bouton, which contained spherical vesicles as well as large number of large dense coredd vesicles. Most of the parameters on the ultrastruotural characteristic and synaptic organization of labeled boutons were similar between S and LDCV boutons, except shapes of containing vesicles. Majority of the labeled boutons showed simple synaptic arrangement. The labeled bouton were frequency presynaptic to dendritic spine, and to a lesser extent, dendritic shaft. They rarely synapsed with soma and adjacent proximal dendrite. A small proportion of labeled boutons made synaptic contacts with presynaptic pleomorphic vesicless containing endings and synaptic triad. Morphometric parameters of labeled boutons including volume and surface area, total apposed area, mitochondrial volume, active zone area, vesicle number and density showed wide variation and theme were not significantly different between S and LDCV boutons. The present study revealed characteristic features on ultrastructure and synaptic connection of pulpal afferents which may involved in transmission of oral pain sensation.

대체의학 선택에 영향을 미치는 일반인들의 심리사회적 특성

유희정,노은여,이철,한오수 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

본 연구의 목적은 대체의학을 선택하는 사람들의 심리사회적 변인을 다차원상에서 분석해 봄으로써 이 요인들이 어떤 방식으로 선택 과정에 영향을 미치는가를 살펴보고, 대체의학을 선호하는 사람들의 특성을 탐색해 보는 것이다. 서울시에 거주하는 일반인 200명(남 92명, 여 108명)을 대상으로 인구 통계학적 특성, 대체의학에 대한 인지도, 정통의학 기법과 대체의학 기법의 특성, 경험한 대체의학 기법의 종류, 성격변인, 대처방식, 건강에 대한 통제감, 사회적 지지를 측정하였다. 본 연구결과, 연구대상 중 약 80%는 한약을 포함한 대체의학적 치료법을 경험해본 것으로 드러났다. 또한, 대체의학적 기법을 선호하는 사람들일수록 대체의학에 대한 인지도가 높고, 연령수준이 높으며, 적극적-행동적 대처방식을 지니고 있고, 건강에 대한 내적 통제감을 지닌 것으로 드러났다. 대체의학에 대한 관심이 급격히 증가하고, 정통의학 기법과는 달리 대체의학적 치료법의 선택에는 심리적인 요인의 영향이 크다는 점을 감안할 때 앞으로 이 분야에 대한 연구가 보다 폭넓게 진행되어야 하겠다. This study examined the characteristics of people who have preference for complementary medicine and also the psychosocial factors that are related to the selection of complementary medicine. Two-hundred subjects recruited from the community were included in this study. Demographic variables, medical service characteristics, health locus of control, social support, coping style, and personality characteristics such as self-esteem, neuroticism, and hypochon-driasis were measured. It turned out that nearly 80% of the subjects had already experienced at least one alternative therapy in the past. However, past experience was not significant in predicting future complementary medicine usage. People who were older in age, had more information about complementary medicine, used active-behavioural coping styles, and had internal locus of control were more likely to use complementary medicine in the future. Recommendations for furthur research is indicated.

도시 개발에 따른 기상장 변동의 3차원 수치해석에 관한 연구

이희철,이범주,이도훈,이은태 경희대학교 산학협력기술연구원 1999 산학협력기술연구논문집 Vol.5 No.-

사업장 근로자의 건강위험 평가도구 개발

홍윤철,임현술,하은희,정규철,조희숙,박혜숙,이용애 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.4

Health Risk Appraisal(HRA) is usually defined as a process by which we expect of individual's chances of death or acquiring specific diseases within a defined period of time. The concept of worksite as an area of health maintenance and promotion is newly developing. Our movement for health promotion of employees has been increasingly known in the worksite. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps; one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers. In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials.