국가예방접종전산등록체계 개발을 위한 민간의료 기관 하부구조 및 환경 조사연구

이무식,김은영,이건세,이석구,홍지영,김건엽,김대경,신의철,이연경,기몽서,나백주,김영택 한국모자보건학회 2003 한국모자보건학회지 Vol.7 No.2

Plenary Session 2 : PS-2-1 ; Outcomes of hepatitis B virus recurrence after liver transplantation: a multicenter analysis in Korea

( Hee Yeon Kim ),( Jong Young Choi ),( Dong Goo Kim ),( Myoung Soo Kim ),( Soon Il Kim ),( Shin Hwang ),( Sung Gyu Lee ),( Kwang Woong Lee ),( Kyung Suk Suh ),( Young Seok Han ),( Dong Lak Choi ),( Se 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: The outcome of hepatitis B virus (HBV) infection after liver transplantation (LT) was improved by hepatitis B immunoglobulin (HBIG) and nucles(t)ide analogue (NUA). However, HBV recurrence after LT is critical because the recurrence is occasionally accompanied by a progressive destruction of graft and poor survival. The aims of this study were to investigate the significance HBV recurrence and identity factors associated with HBV recurrence. Methods: From October 1999 to February 2011, a total of 2684 consecutive LT recipients who underwent HBV-associated LT were retrospectively enrolled from 7 transplantation centers in Korea. Results: Prophylaxis regimens were HBIG monotherapy (67.7%) or a combination of HBIG with NUA (22.3%). The recurrence rate of HBV was 6.1% (164 recipients) during mean follow-up duration of 10.9 years. The median time from transplantation to recurrence was 2.1 years (0.1-7.9 years). Of the 1,071 patients with hepatocellular carcinoma (HCC) prior to LT, 155 patients (14.5%) had HCC recurrence after transplantation, and 48 patients (31.0%) had HBV recurrence. Of the 48 patients with recurrence of both HBV and HCC, 25 patients (52.1%) experienced HBV recurrence after HCC recurrence. In the multivariate analysis, pretransplant HCC, pretransplant HBV DNA above 5.5 log copies/mL was independent clinical factors influencing HBV recurrence after LT. The mortality rate among the recipients with HBV recurrence was 34.1% (56 recipients). Mean overall survival was 6.4 years in the HBV-recurrence group and 9.9 years in the HBV-nonrecurrence group (p<0.001). HBV recurrence was not an independent prognostic factor for overall survival. HCC recurrence was the most important factor for overall survival. Conclusions: The overall outcome of LT in HBV-related liver disease was excellent with the current prophylaxis regimen Choon Hyuck David Kwon,8 Suk-Koo Lee8 Pretransplant HBV DNA and HCC were important factors for HBV recurrence. HBV recurrence after LT did not significantly influence on the overall survival without combining of HCC recurrence.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

자가 면역성 간염에서 자가항체의 발현 양상과 스테로이드 치료의 효과

박기오,채경훈,허원석,강윤세,정재훈,김연수,문희석,이엄석,김선문,이병석,김남재,이헌영 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

목적 : 최근 8년간 본원에서 경험한 자기면역성 간염의 혈액학적 특징과 스테로이드의 치료효과를 알아보고자 본 연구를 시행하였다. 방법 : 1996년 이후부터 2002년까지 충남대학교 병원에서 1999년 International Autoimmune Hepatitis Group(LAHG)에서 제시한 수정 진단 기준안에 의거하여 총 진단점수가 probable 이상에 해당하는 환자들을 대상으로 임상적 특징, 검사실 및 조직 소견과 스테로이드와 azathioprine의 치료 효과를 후향적으로 조사하였다. 결과 : 9예의 환자들은 여성이 78%, 40대가 많았고, 급성 발병이 33.3%, 피로감, 식욕부진 및 황달 등이 나타났으며, 항핵항체가 55.6%에서 그리고 항평활근 항체가 77.8%에서 양성이었고, 동반 질환은 류마치스 관절염이 2예, 특발성 혈소판 감소증 1예, Henoch-Sch nlein 자반증 및 그레브스병이 각각 1예 씩이었다. 7예에 대해서 스테로이드와 azathioprine으로 치료하여 생화학적 임상적 완해가 이루어져서 유효한 치료 결과를 얻었다. 결론 : 자가면역성 간염은 우리 나라에서 원인을 찾을 수 없는 만성 간질환의 경우, 특히 중년여성에서 다른 자가면역성 질환이 동반되었을 때 자가면역성 간염을 의심하여 자가항체 선별검사를 시행해 보아야 할 것으로 생각된다. 향후 다기관 연구를 통하여 좀 더 많은 증례를 모으고 전향적인 연구를 시행하여야 할 필요가 있다. Although autoimmune hepatitis(AIH) is common in western contries, some studties have been reported in Korea. The aim of the study was to analyze the clinical and histological features and expression pattern of the autoantibody and to examine clinical course of AIH in Korea. For 9 patients diagnosed as having AIH in our hospital since 1996, we reviewed medical records and analyzed clinical and laboratory findings retrospectively. They had a probable or definite AIH according to the revised criteria of International AIH group. The mean age was 42.7(21∼68)years and 7(77.8%) were female. Three of them(33.3%) showed acute hepatitis and five of them showed cirrhosis. Fatigue and anorexia were the most frequently complained symptoms(55.6%). Four patients(44.4%) were accompanied with other autoimmune diseases. Antinuclear antibody was detected in 5(55.6%) and anti-smooth muscle antibody was detected in 7(77.8%). Three patients showed focal picemeal necrosis and four showed periportal fibrosis. Among 7 patients who received immunosuppressive therapy, six patients(85.7%) showed initial response. and biochemical and serologic remission were achived in 5(71.4%) and 3(42.8%) patients, AIH seems to be partly responsible for chronic liver disease of unknown etiology in Korea. AIH should be suspected in female patients with unknown chronic liver disease of unknown etiolgy, especially accompanied with other autoimmune disease. The clinical characteristics of AIH may not be quite different from those of Western countries.

손가락에 발생한 피하 석회화 결절 1예

이원채,차영창,이석종,나건연,김도원,이수경 대한피부과학회 2003 대한피부과학회지 Vol.41 No.10

Subepidermal calcified nodule is a rather uncommon, but peculiar subtype of calcinosis cutis. It presents as a single asymptomatic, hard, yellowish white nodule which commonly occurs on the face of chileren. Histopathologic examination reveals the multifocal various-sized papillary dermal collection of dark blue amorphous globular deposits confirmed by von Kossa stain for calcium. We report a 42-year-old man who had small white hyperkeratotic papule on finger tip for more than 20 years. He could recall neither preceding trauma nor systemic illness. Excisional biopsy, with the clinical impression of verruca or corn, showed typical histopathologic features of the subepidermal calcified nodule.(Korean J Dermatol 2003;41(10) : 1414~1416)

우리 나라 종합병원 진료재료 구매와 재고관리 질 향상 방안에 관한 연구

이연희,윤석준 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.1

This study was conducted to investigate the current situation of medical supply purchasing and stock management at general hospitals having more than 150 beds in Korea and to find methods of effective purchasing and optimal stock management. Methods : Survey was done from staff at the purchasing departments of 299 general hospitals throughout Korea. Data collection was done using a structured questionnaire between January 3 to March 15, 2001. The survey form was returned from 88 hospitals (rate of return:38.4%). Results : Firstly, 13.6% of the hospitals did not carry the optimal stock of medical supplies, the lead time optimal stock was 3 weeks or longer in 64.4% of the hospitals. Secondly, since 69.8% of the hospitals showed passive attitude toward training on purchasing management and stock management techniques. Thirdly, as for the question on the presence or absence of a deliberation committee for purchasing of new medical supplies, 60% of the hospitals with less than 300 beds did not have one, and 9.4% of the hospitals opened the deliberation committee less than twice a year. Conclusion : At the time of purchasing new medical supplies, purchasing should be done according to the decision by the deliberation committee so that no deduction is made at the time of claiming insurance, and by setting a certain period of time, purchasing of those medical supplies that were not purchased during this period needs to be done according to the decision by the deliberation committee.

능동 지원 규칙시스템 설계

이연식,강석권 群山大學校 情報通信技術硏究所 1998 情報通信技術硏究論文集 Vol.2 No.-

The active database system which is added conditional action functionality to the traditional database systems can support various and available functions(e.q. maintenance of integrity and security, access logging, alert, etc.) effectively. This paper presents a concept of rules which are able to support the active mechanism efficiently and designs a rule system for processing of the various rules. The proposed rule system, which is tightly coupled integrated structure, provides the efficient methods for integration and management of rules in database environment. And also, because it allow the effective processing of rules by integrations with transaction manager, data manager, query processor, and other components of database system, it contributes to the design and implementation of active database system.

청소년기 문제행동과 부모 양육행동에 관한 연구

손석한,노경선,허묘연,정현옥,이소희,김세주 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 일반 청소년의 문제행동(내재화 문제, 외현화 문제)을 평가하고, 그들을 정상 집단과 문제행동 집단으로 나누어 집단간에 부모 각각의 양육행동이 어떠한 차이를 보이는지 알아보고자 한다. 방 법 : 서울 소재의 일반 고등학교 학생 792명을 대상으로 부모 양육행동 척도와 K-YSR을 실시하여 청소년이 지각하는 부모의 양육행동과 청소년의 문제행동을 평가하였다. 부모의 양육행동과 청소년의 문제행동과의 상관관계를 분석하였다. 학생들이 보고한 각 문제행동을 상/하위 25% tile을 기준으로 정상 집단과 문제행동 집단으로 나누어 부모의 양육행도의 차이를 분석하였다. 결 과 : 다음과 같다. 1) 부모의 애정, 합리적 설명, 감독의 긍정적인 양육행동은 대부분의 청소년 문제행동들과 유의한 부적 상관을 보였다. 반면에 학대, 과잉간섭, 과잉기대, 방임, 비일관성이 부정적인 양육행동은 문제행동들과 유의한 정적 상관이 있었다. 2)내재화 문제를 보이는 청소년들은 정상 집단에 비해 부모로부터 학대, 과잉간섭, 과잉기대, 방임, 비일관성의 양육행동을 유의하게 더 많이 받았고, 반면에 애정을 유의하게 더 적게 받았다고 지각하고 있었다. 외현화문제를 보이는 청소년들은 정상집단의 청소년들에 비해 부모로부터 학대, 과잉간섭, 과잉기대, 방임, 비일관성의 양육행동을 유의하게 더 많이 받았고, 반면에 감독을 유의하게 더 적게 받았다고 지각하고 있었다. 3) 내재화 및 외현화 문제를 모두 보이는 집단이 내재화 문제만 보이는 집단과 외현화 문제만 보이는 집단에 비해서 양쪽 부모로부터 유의하게 더 많은 과잉간섭을 받을 것으로 지각하고 있었다. 또한, 내재화-외현화 집단과 내재화 집단은 외현화 집단에 비해서 어머니로부터 유의하게 더 적은 애정과 더 많은 방임을 받고 있고, 아버지로부터 유의하게 더 많은 학대를 받은 것으로 지각하고 있었다. 결 론 : 이상의 결과로 미루어 볼 때, 청소녕이 지각한 부모의 학대, 과잉간섭, 과잉기대, 방임, 비일관성의 양육행동은 청소년의 내재화 및 외현화 문제 모두와 유의한 연관이 있고, 반면에 부모의 애정, 감독, 합리적 설명의 양육행동은 다양한 청소년기 문제행동을 줄일 수 있음을 시사하고 있다. Objectives : The purpose of this study is to evaluate the problem behaviors of adolescents and to discriminate between parenting behaviors of problem behavior groups and those of non-problem behavior group. Methods : The subjects of this study were 792 high school students in Seoul. We administered 'parenting behavior Inventory' and Korean version of Youth Self-Report(K-YSR) to the subjects in order to evaluate the parenting behaviors perceived by adolescents and the problem behaviors of adolescents. We analzed the relationship between parenting behaviors and problem behaviors. We classified the subjects into problem behavior groups(internalizing group, externalizing group, internalizing-externalizing group) and a non-problem behavior(normal) group. We studied the differences of parenting behaviors among the groups. Results : The results are as follows. 1) There were significant negative correlations between the positive parenting behaviors such as affection, reasoning, and monitoring and the problem behaviors of adolescents. By contrast, there were significant positive correlations between the negative parenting behaviors such as physical abuse, intrusiveness, over-expectation, neglect, and inconsistency and the problem behaviors of adolescents. 2) Adolescents of the internalizing group perceived significantly more parental abuse, intrusiveness, over-expectation, neglect, and inconsistency than those of normal group. Meanwhile, they perceived significantly less affection than normal adolescents. Adolescents of the externalizing group also perceived significantly more parental abuse, intrusiveness, over-expectation, neglect, and inconsistency than those of normal group. Also, they perceived significantly less monitoring than normal adolescents. 3) Adolescents of the internalizing-externalizing group perceived significantly more intrusiveness from both parents than those of either the internalizing or the externalizing groups. Adolescents of the internalizing-externalizing group perceived significantly less affection and more neglect from their mothers than those of the internalizing of the externalizing groups. In addition, adolescents of the internalizing-externalizing group perceived significantly more physical abuse from their fathers than those of the internalizing or the externalizing groups. Conclusion : Parenting behaviors such as abuse, intrusiveness, over-expectation, neglect, and inconsistency are associated with both internalizing and externalizing problems. In contrast, our results suggest that parenting behaviors such as affection, monitoring, and reasoning might decrease the various problem behaviors of adolescents.

독성물질의 세포사 기전 및 세포사 유발물질의 검색법 개발에 관한 연구(Ⅰ) : 독성물질로 인한 파킨슨병 모델에서의 세포사 기전 연구 Study on the cell-death mechanisms of toxin-induced parkinsonism

강태석,김종민,서경원,김영옥,김준규,오재호,이윤동,김규봉,오정자,송연정,임종준,전범석,문전옥,최광식 식품의약품안전청 2000 식품의약품안전청 연보 Vol.4 No.-

MPTP 독성물질이 도파민성 신경세포에 선택적으로 작용하여 산화성 손상에 의한 신경세포사를 일으키는 것을 이용하여 파킨슨병의 동물모델을 만들고, 이를 통해서 아폼토시스를 비롯한 포사의 기전에 대한 연구 및 너코틴의 신경세포 보호효과 여부를 판정하는 실험을 병행하고자 하였다. 파킨슨꾐의 동물모델을 MPTf 독성 물질을 이용하여 확립하였으며, MPTP(30mgag, i.p.)를 투여한 후 1, 2,3, 4, 5일째 흑질 조직을 채춰하여 tarm로 박걸하여 tyrosine hydroxylase 면역조직화학염색을 수행하여 cell countif우한 결과, control은 57.635ce11s, 1일째 친.OfDells,2일째 57.9±6cells,3일릴 없.3±죠ells, 4일째 49.0츠3cells, 5일째 39.4±Scells료 4, 3일째 뚜렷한 신경세포 수의 감소를 보였다. 신경세포사 기전 규명을 위한 아폼토시스 분걱에서는 벼PTP 투여 후 1, 2, 3, 4, 5일째 조직을 채취하여 Hoechst staining, TUNEL staining을 수곡하였는데 양성 반응을 보인 신경세포는 관찰되지 않아. 아폼토시스로 인한 세포사가 관찰되지 않았다. bIPTP 파킨슨병 동물모델에서 nicotine 보호효과 탐색에 관한 실험은 nicat푸e 0.2mgAg을 5일 퐁안 투여 후 리『fP(30mgag)를 CS7Bt/6 마은스에 복강 내주사로 nicotine과 병용 투여한 후 1, 2, 3, 4, 5일째 뇌를 적출하땄다. 신경세포사가 뚜렷이 관찰되기 시작하는 4, 5일째의 신경세포 수의 감소 정도를 20. 30% 정도 약화시키는 경향을 보였으나, nicotine 보호효과에 대한 추가 실헝이 현재 수행 중에 있다. The cause of Parkinson's disease (PD) is largely unknown. However, free radical toxicit? may plaf a role ip. the degeneration of substantia nigra, which is the Hajorfocus of pathological damages in PD. Recently, a neuroprotective effect of nicotine in PD has been suggested. Therefore, the mechanism of neurodegenerafion and protective potential o( nicotine in PD were investigated in the experimental modeB of Pll using a neurotoxin, C57BL/6mice were administered with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 30 mg/kg,j.p.). The degree of neurodegenerafion was determined by immunohistochemical stainiHB oftyrosine hydroxylase (TH). TH-positive cells on nigral sections were found 56.0 ±4, 57.9 ±6,52.315ce11s, 49.0±3cells, and 39,4±Scells at days 1, 2, 3, 4, 5, respectively (controls : 57.6±Scells). Hoechst and TUNEL staining showed no evidence of apoptosis. The exandnation on themice co-adrunistered with nicotine(0.2mgAg) and MPTP(30mgag) revealed a tendency ofnicotine protective effects. At days 4 and 5, the degree of TH-positive cells was decreased by20-30%, In corclusiffn, the role of apoptosis was not evidenced in this MPTP modeB of PB.The possible proteccon by nicotine should be elucidated with further studies.

스타이렌 아이오노머의 기계적인 성질에 미치는 혼합 양이온의 영향

김희석,나연화,이용혁,이법원,유지강,박기주,김준섭 조선대학교 생산기술연구소 1998 生産技術硏究 Vol.20 No.1

The styrene-co-methacrylate ionomers neutralized with Na +, Ba2 +, and mixed cation of both were prepared. The dynamic mechanical properties of two cation-containing ionomers were measured and compared to those of the ionomers neutralized with only one type of cations. We found that in the ionomers with one type of cations the difference in the type of cation does not change the glass transition temperatures. It was found, however, that the cluster Tg of the mixed cation ionomer is lower than that of the single cation ionomers. Thus it was postulated that in the two-cation system the two cations in a solution have sufficient dynamics to form new type of multiplet containing both cations, which may be slightly bigger than that found in the single cation multiplet. The mechanical properties also imply that the strength of ion interactions in the multiplets of the two cation ionomer is thought to be weaker than that of the one cation ionomers. These two effects are believed to contribute the lower in the cluster glass transition of mixed cation system.