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.

The clinical and economic burden of communityonset complicated skin and skin structure infections in Korea

Yong Kyun Cho,Heung Jeong Woo,Shin-Woo Kim,In-Gyu Bae,Young Goo Song,Hee Jin Cheong,Hyuck Lee,Sang Hoon Han,Hee Jung Choi,Chisook Moon,Seong Yeol Ryu,Jian Hur,Jacob Lee,Yu Mi Jo,Young Joo Kim 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.6

Background/Aims: To investigate epidemiologic characteristics, clinical and economic burdens, and factors associated with mortality in complicated skin and skin structure infection (cSSSI) patients in Korea. Methods: A retrospective, observational, nationwide study was conducted between April to July 2012 at 14 tertiary-hospitals in Korea. Eligible patients were hospitalized adults with community acquired cSSSI, who underwent surgical intervention and completed treatment between November 2009 and October 2011. Data on demography, clinical characteristics, outcomes and medical resource utilization were collected through medical record review. Direct medical costs were calculated by multiplying quantities of resources utilized by each unit price in Korea. Results: Of 473 patients enrolled, 449 patients (except 24 patients with no record on surgical intervention) were eligible for analysis. Microbiological testing was performed on 66.1% of patients and 8.2% had multiple pathogens. Among culture confirmed pathogens (n = 297 patients, 340 episodes), 76.2% were gram-positive (Staphylococcus aureus; 41.2%) and 23.8% were gram-negative. The median duration of hospital stay was 16 days. Among treated patients, 3.3% experienced recurrence and 4.2% died in-hospital. The mean direct medical costs amounted to $4,195/ person, with the greatest expenses for hospitalization and antibiotics. The in-hospital mortality and total medical costs were higher in combined antibiotics therapy than monotherapy (p < 0.05). Charlson’s comorbidity index ≥ 3, standardized early warning scoring ≥ 4, sub-fascia infections and combined initial therapy, were all found to be associated with higher mortality. Conclusions: Korean patients with community-onset cSSSI suffer from considerable clinical and economic burden. Efforts should be made to reduce this burden through appropriate initial treatment.

치아회분과 석고혼합제재 매식과 자가골 동시 이식후 치유과정에 관한 실험적 연구

김영균,김흥중,이상호,여환호,임성철,설인택,정재헌 大韓顎顔面成形再建外科學會 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.1

The purpose of this study was to evaluate the efficacy of adding autogenous bone to the toothash-plaster mixture in the healing process of bone. Full-thickness round osseous defects with the diameter of 20mm were made at the calvarial bone of adult dogs (n=19) bilaterally, which were thought to be critical size defect. The right defects were repaired with the toothash-plaster mixture plus autogenous bone (compressed volume 0.3cc) and the left defects with only toothash-plaster mixture. At 2-, 4-, 8-, 12- and 20- week after implantation, dogs were sacrificed and evaluated the osseous healing of bony defects clinically, radiographically, and microscopically. The results were as follows : 1. At the clinical observation, the wound healed very well without any problem except severe swelling in the early period after operation. Slight depression was recognized at the both sides when the portions of cranial defect were palpated. 2. There were statistically significant differences between toothash-plaster mixture groups and autogenous bone added groups at the same period, and among the groups in the bone density of the digital radiograms (P<0.001).There was a tendency that bone density was increasing with time. 3. In light microscopic examination, new bone formation was more active in the autogenous bone added groups than toothash-plaster mixture groups at the early period after mplantation but there is little difference at 20-week after implantation. 4. In fluorescent microscopic examination, the fluorescent band could be observed at the area of active bone formation and the band was more distinct in the autogenous bone added groups then toothash-plaster mixture groups. 5. In transmitted electron microscopic examination, organelles such as rER, Golgi complex and secretory granule and osteoblast were observed. In summary higher volume ratio of autogenous bone is needed to improve the bone healing in that there is little difference between toothash-plaster mixture group and autogenous bone added group at the 20-week after implantation in spite of new bone formation was more active in the autogenous bone added groups than toothash-plaster mixture groups at the early period after operation.

國民學校 및 中學校의 科學科 敎育課程의 系列性에 關한 硏究(物理科學分野)

宋寅命,禹榮均,金千中 공주대학교 사범대학 과학교육연구소 1976 과학교육연구 Vol.8 No.1

The results of the examination for the new science curriculum shows that the selection and arrangement of the contents of the teaching subjects is reasonable, but that the contents is difficult and the quantity of the subjects is abandant in both side of teaching and learning is dominant opinion. The results of the sequence analysis of the teaching contents are as follows: (1) the selection of the fundamental concepts, the level of teaching in primary and junior high school, and the sequence of the contents are of no gross faults. (2) The sequence of the "Waves" included the properties of light is cut off, because they do not deal with the waves in the energy concept in junior high school. (3) The unit, "Magnetic Effect of a Current" is dealt with in interaction unit in primary school, and on the other hand it is dealt with in energy unit in junior high school. So, there is room for examination in magnetic effect of current from a viewpoint of the concept development and sequence maintenance. Next, we discussed the theoretical background for the formation of sequence and especially have set up the hierarchy of the inquiring process, in the viewpoint of organizing the contents and techniques dealt with in inquiring activities. And, on the basis of a survey of public opinion, analysis of sequences, and general theory of formation of sequence, we proposed the general rule for organizing the sequence of the concepts and the process-skills between the primary and the junior high school, and for organizing the sequence of the seience curriculum in itself. On the basis of these discussion, we have selected some unit and framed the teaching programme which will serve as a good reference to the practical teaching. We hope that a large number of teachers put the contents proposed in this paper and teaching programme organized process-skills into practical use, and they research and practice the various teaching techniques continuously in order to reach to educational purpose of the new science curriculum.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

Condylar positioning changes following unilateral sagittal split ramus osteotomy in patients with mandibular prognathism

Kim, Myung-In,Kim, Jun-Hwa,Jung, Seunggon,Park, Hong-Ju,Oh, Hee-Kyun,Ryu, Sun-Youl,Kook, Min-Suk Korean Association of Maxillofacial Plastic and Re 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-

Background: This study was performed to evaluate three-dimensional positional change of the condyle using three-dimensional computed tomography (3D-CT) following unilateral sagittal split ramus osteotomy (USSRO) in patients with mandibular prognathism. Methods: This study examined two patients exhibiting skeletal class III malocclusion with facial asymmetry who underwent USSRO for a mandibular setback. 3D-CT was performed before surgery, immediately after surgery, and 6 months postoperatively. After creating 3D-CT images by using the In-vivo $5^{TM}$ program, the axial plane, coronal plane, and sagittal plane were configured. Three-dimensional positional changes from each plane to the condyle, axial condylar head axis angle (AHA), axial condylar head position (AHP), frontal condylar head axis angle (FHA), frontal condylar head position (FHP), sagittal condylar head axis angle (SHA), and sagittal condylar head position (SHP) of the two patients were measured before surgery, immediately after surgery, and 6 months postoperatively. Results: In the first patient, medial rotation of the operated condyle in AHA and anterior rotation in SHA were observed. There were no significant changes after surgery in AHP, FHP, and SHP after surgery. In the second patient, medial rotation of the operated condyle in AHA and lateral rotation of the operated condyle in FHA were observed. There were no significant changes in AHP, FHP, and SHP postoperatively. This indicates that in USSRO, postoperative movement of the condylar head is insignificant; however, medial rotation of the condylar head is possible. Although three-dimensional changes were observed, these were not clinically significant. Conclusions: The results of this study suggest that although three-dimensional changes in condylar head position are observed in patients post SSRO, there are no significant changes that would clinically affect the patient.

성인병에 대한 한방치료법(증치의학과 사상의학)에 관한 연구 : 고혈압에 대한 한방치료법(중치의학과 사상의학)에 관한 연구

박동일,김영균,안창범,이인선,김종원,권정남,장경전,이인선,이성근,장용우,신영민 동의대학교 한의학연구소 1999 동의한의연구 Vol.3 No.-

We had a result of the treatment as below when is devided Korean medicine Tx.. Western medical Tx., Cooperative Tx.. 1) At the improvement of BP control, an average in Korean medicine Tx. (from 170㎜Hg/100㎜Hg to 150㎜Hg/90㎜Hg), an average in Western medical Tr. (from 170㎜Hg/100㎜Hg to 130㎜Hg/80㎜Hg), an average in Cooperative Tx.(from 180㎜Hg/110㎜Hg to 130㎜Hg/90㎜Hg), generally all pars had improvements of BP control. But it is not significant of each case. 2) At the improvement of symptoms by the apologetics, Cooperative Tx. is profitable in cases of 'GanHwa',' DamEum', 'EumYangYangHer', 'EumHer'. Korean medicine Tx. is superior in case of 'GiChe'. 3) At the improvement of symptoms by a questionnaire, Korean medical Tx., Western medical Tx., Cooperative Tx. groups had improvements, but each practice group didn't have specific significance. Only it was somewhat profitable to Korean medical Tx. in the 210㎜Hg/110㎜Hg, Western medical Tx. in the 180㎜Hg/110㎜Hg, Cooperative Tx, in the 170㎜Hg/90㎜ Hg. 4) There are the apparent improvements in patients whose BP are over 200㎜Hg of Korean medical Tx. group, whose BP are over 190㎜Hg of Western medical Tx. group and whose BP are over 170㎜Mg of Cooperative Tx. group. There are the improvement of diastolic BP in 110㎜Mg(Korean medical Tx., Western medical Tx.) and 90㎜Hg(Cooperative Tx.). 5) At the improvement of Pulse pressure, generally Pulse pressure are decreased. There are similar improvements in all of Korean medical Tx., Western medical Tx., and Cooperative Tx.. 6) At the Symptomatic approvement according to ages, Korean medical Tx., Cooperative Tx. are somewhat good for his twentieth, and Western medical Tx. is somewhat good for his forties. 7) the correlation of Obesity-grade and BP, as Obesity-grade is higher as BP is higher, but there are no similarity in the improvement. 8) At the EAV improvements, as examination into correlation with the point of 1~3th, we could get results as below. There are high improvements of DRHTM, DRALM, DLLYM, DLLIM in Cooperative Tx. There are high improvements of DRPASI, DLLARI in the Korean medical Tx. group. There are high improvements of DRFADM in Western medical Tx. group.

장기간 항경련제를 복용한 간질환자의 골대사 변화에 대한 연구 : DR-XRA(Quantitative Dual-Energy Radiography ; X-Ray Absorptiometry)법에 의한 측정 Measurement by DR-XRA(Quantitative Dual-Energy Radiography ; X-Ray Absorptiometry)

이호택,장호균,이상연,정인과 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.1

This study examined, among others, the relationship between the use of anticonvulsant and the bone mineral metabolism(measured via DR-XRA and biochemical study) in 46 adult epileptic outpatients who had been on anticonvulsant for more than one year at Seoul Red Cross Hospital. The study findings wel as follows. 1) There was statistically significant difference between index group(i.e. 46 adult epileptic outpatients) and control group(i.e. 46 healthy adults without previous exposure to anticonvulsant) in terms of bone mineral density. Specifically, the bone mineral density in the epileptic outpatients was significantly lower than that in the healthy adults. Although there was no statistically significant difference between male and female outpatients, their bone mineral density tended to decrease with the increase of age. 2) The bone mineral density in the epileptic outpatients was negatively correlated to both ⅰ) the age when the outpatients started anticonvulsant treatment and ⅱ) the period for which the outpatients were on anticonvulsant. 3) Index group was further classified into three subgroups(i.e. low, normal and high subgroup) based on the mean and standard deviation of the bone mineral density in healthy adults control group. 24 outpatients(5.2%) out of 46 fell into low subgroup, of which 10 were male. Overall, there was no statistically significant difference between male and female outpatients in terms of their bone mineral density. 4) Low subgroup's average age(38.6 with SD of 12.5) was significantly higher than those of the other two subgroups. Low subgroup started anticonvulsant treated when their average age was 24.8(SD 15.0) years, which was higher than those of the other two subgroups. Low subgroup was on anticonvulsant, on average, for 13.3(SD 7.6) years, which was also higher than those of the other two subgroups although there was no significant difference among the subgroups. 5) A series of comparison regarding the possible impact of various types of anticonvulsant(e.g. PHT, CBZ PB, SV) in terms of ⅰ) overall dosage and ⅱ) daily average dosage on bone mineral density showed no significant difference across the three subgroups. 6) There was no significant difference in terms of bone mineral density between the epileptic outpatients on only one type of anticonvulsant and those on two or more types of anticonvulsant. 7) A biochemical study showed that ⅰ) each subgroup fell into normal range in terms of blood serum Ca, P, and ALP with no significant difference among the subgroups, and ⅱ) in low subgroup, there were 6 outpatients(25%) with Ca decrease, 2(9.5%) with P decrease, and 5(20.8%) with ALP increase.

토끼 수막염 모델을 이용한 다제내성 폐렴구균에 대한 Meropenem의 치료 효과

김신우,진정화,강수정,정숙인,김연숙,기현균,김춘관,이혁,김성민,백경란,송재훈 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.1

목적 : 다제내성 폐렴구균에 의한 수막염은 기존과 단일 항생제로는 근치가 어려워 ceftriaxone과 vancomycin 혹은 rifampin의 병용요법이 권유되고 있다. 다제내성 폐렴구균에 사용할 수 있는 다른 약제 중 meropenem은 시험관내 폐렴구균에 대한 항균력이 좋고 경련 등의 중추신경계 부작용이 거의 없어 다제내성 폐렴구균에 의한 수막염의 치료에 이용할 수 있을 것으로 기대되나 이에 대한 자료가 매우 부족한 상태이다. 이에 연자 등은 meropenem과 meropenem+vancomycin의 병용요법이 다제내성 폐렴구균 수막염의 치료에 효과가 있는지를 토끼 수막염 동물 모델을 이용하여 검증하고자 하였다. 방법 : 인체에서 수막염을 일으킨 다제내성 폐렴구균 균주(penicillin MIC 2, ceftriaxone MIC 4, meropenem MIC 0.5㎍/㎖)를 토끼 척수강 내에 직접 주입하여 수막염을 유발한 후 ceftriaxone, vancomycin, rifampin, meropenem의 단일 항균요법, ceftriaxone+vancomycin, ceftriaxone+rifampin, meropenem+vancomycin의 병용요법 간에 치료 효과의 차이를 비교 하였다. 각 치료군은 6 마리의 토끼를 대상으로 하였다. 각각의 항생제는 5 시간 간격으로 2번 정주하였으며, ceftriaxone은 1회 투여하였다. 균주 주입 후 각 치료군이 토끼에서 치료 후 0, 5, 10, 24 시간에 척수액을 채취하여 균주의 수를 측정하여 24시간째의 살균 여부를 최종 치료 효과로 판정하였다. 결과 : meropenem 단독 요법은 10시간째에 모든 균주를 살균하였으나 24시간 째에 다시 균의 성장이 관찰되었으며, meropenem+vancomycin의 병용요법은 단독 약제보다 우수한 살균효과를 보였으나 상승작용은 없었다. 결론 : meropenem+vancomycin의 병용요법은 기존의 ceftriaxone+vancomycin보다 24시간째에 더 큰 균의 감소 경향을 보여(P=0.054) 임상에서 사용이 가능할 것으로 기대되며 향후 실제 수막염 환자에서의 임상효과를 증명하는 연구가 필요할 것으로 생각된다. Background : Because antimicrobial monotherapy for pneumococcal meningitis caused by penicillin-resistant strains is not satisfactory, ceftriaxone+vancomycin [C+V] or ceftriaxone+rifampin [C+R] regimens are recommended. Meropenern [M] is one of the monotherapy options for penicillin-resistant pneumococcal meningitis due to good in-vitro activity against pneumococci and rare adverse reactions in CNS. But there have been few reports in the efficacy of meropenern against pneumococcal meningitis. We evaluated therapeutic efficacy of the meropenern and meropenem+vancomycin in a rabbit model of meningitis caused by penicillin-resistant S. pneumoniae (PRSP). Methods : Meningitis was induced by intracistemal inoculation of a pneumococcal strain isolated from a patient with meningitis (MIC; penicillin 2, ceftriaxone 4, meropenem 0.5 g/㎖). Bacterial concentrations in the CSF were measured at 0, 5, 10, and 24 h after therapy was started. Therapeutic efficacy was evaluated by the final bacterial concentration in the CSF at 24 h. Results : C+V cleared the CSF at 10 h, but regrowth of bacteria was noted at 24 h. Meropenem monotherapy resulted in sterilization at 10 h but regrowth at 24 h. M+V was superior to M or V monotherapy but did not show synergism. Therapeutic efficacy of M+V was at least equal or superior to that of C+V (P = 0.054). Conclusion : Meropenem+vancomycin regimen could be one of the useful options in the treatment of PRSP meningitis. Clinical trials to evaluate the M or M +V are warranted in the future.

Validation of Sea Surface Temperature (SST) from Satellite Passive Microwave Sensor (GPM/GMI) and Causes of SST Errors in the Northwest Pacific

Kim, Hee-Young,Park, Kyung-Ae,Chung, Sung-Rae,Baek, Seon-Kyun,Lee, Byung-Il,Shin, In-Chul,Chung, Chu-Yong,Kim, Jae-Gwan,Jung, Won-Chan The Korean Society of Remote Sensing 2018 大韓遠隔探査學會誌 Vol.34 No.1

Passive microwave sea surface temperatures (SST) were validated in the Northwest Pacific using a total of 102,294 collocated matchup data between Global Precipitation Measurement (GPM) / GPM Microwave Sensor(GMI) data and oceanic in-situ temperature measurements from March 2014 to December 2016. A root-mean-square (RMS) error and a bias error of the GMI SST measurements were evaluated to $0.93^{\circ}C$ and $0.05^{\circ}C$, respectively. The SST differences between GMI and in-situ measurements were caused by various factors such as wind speed, columnar atmospheric water vapor, land contamination near coastline or islands. The GMI SSTs were found to be higher than the in-situ temperature measurements at low wind speed (<6 m/s) during the daytime. As the wind speed increased at night, SST errors showed positive bias. In addition, other factors, coming from atmospheric water vapor, sensitivity degradation at a low temperature range, and land contamination, also contributed to the errors. One of remarkable characteristics of the errors was their latitudinal dependence with large errors at high latitudes above $30^{\circ}N$. Seasonal characteristics revealed that the errors were most frequently observed in winter with a significant positive deviation. This implies that SST errors tend to be large under conditions of high wind speeds and low SSTs. Understanding of microwave SST errors in this study is anticipated to compensate less temporal capability of Infrared SSTs and to contribute to increase a satellite observation rate with time, especially in SST composite process.