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.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

피압수가 존재하는 연약점토지반 내에 연직배수재의 관입깊이에 따라 압밀거동에 미치는 영향

정성교,진현식,백승훈 동아대학교 건설기술연구소 1999 硏究報告 Vol.22 No.2

In the Yangsan area developed for housing complex the soft clay deposited as about 20 to 40 meters in thickness and there was the Artesian pressure of about 20kPa under the clay stratum. To investigate the consolidation behaviour due to partially or fully penetrating vertical drains in the clay layer, a finite element analysis was carried out in this study. As a result of analysis, it was shown that the consolidation rate and the final settlement for the case of fully penetrating vertical drains were faster and less than of partially penetration, respectively.

저신장 소아에서 성장호르몬 치료가 두개안면필 성장에 미치는 영향

정성호,김진욱,박용훈,황충주,이희경 대한치과교정학회 2010 대한치과교정학회지 Vol.40 No.4

Objective: The purpose of this study was to analyze the effect of growth hormone treatment (GHT) on craniofacial growth in children of short stature. Methods: Nineteen untreated children of short stature were referred from the Pediatric Department, Yeungnam University Hospital as a subject group. All subjects had lateral cephalograms taken before, after 1 year and after 2 years of growth hormone treatment. As a reference group, we selected 19 normal children with paired sampling who matched the subjects' age and sex, from the Department of Orthodontics, Kyungpook National University Hospital. Results: Before GHT, anterior cranial base length and upper posterior facial height, posterior total facial height, mandibular ramus length, and mandibular corpus length were significantly smaller in the reference group. In angular craniofacial measurements, saddle angle and mandibular plane angle were larger. SNA and SNB were smaller in the reference group. After two years of GHT, growth hormone accelerated growth in several craniofacial components. The posterior total facial height, the anterior, posterior cranial base length, and the mandibular ramus length were increased. And the difference in mandibular plane angle and ANB values compared with the reference group was decreased. Conclusions: GHT over 2 years leads to a craniofacial catch-up growth tendency, which is pronounced in interstitial cartilage and condylar cartilage. 저신장이란 같은 연령 및 성별 소아들의 표준 신장 평균치에서 -2.0 SD 이하인 경우를 말한다. 본 연구의 목적은 저신장 소아의 두개안면골격의 특성을 분석하고, 성장호르몬 치료가 신장을 성장시킴과 동시에 두개안면골격에 어떤 영향을 주는지 알아보고자 함이다. 영남대학교 의과대학 부속병원 소아청소년과에서 저신장으로 진단받은 소아를 대상으로 성장 호르몬 치료 전 그리고 치료 후 1년, 2년 후 총 3회 측모 두부 방사선 규격 사진의 촬영을 시행하였다. 대조군은 경북대학교 치의학전문대학원 교정과에 소장된 한국인 평균 신장의 2 표준오차 내의 아동들을 대상으로 측모 두부 방사선 규격사진을 2년마다 10년간 촬영한 자료를 이용하여 저신장 소아의 연령과 성별을 기준으로 짝진 표집(paired sampling)을 하였다. 성장 호르몬 치료 전 저신장 소아는 작고 후퇴된 하악골과 편평한 두개저를 가지는 것으로 나타났다. 성장 호르몬 치료 후 anterior, posterior cranial base length, upper posterior facial height, lower anterior facial height, posterior total facial height, mandibular ramus length, mandibular corpus length와 overall mandibular length 성장량이 정상군에서의 2년 성장량과 비교했을 때 유의하게 큰 것으로 나타났으며 각도 계측에서는 saddle angle, mandibular plane angle과 ANB변화량이 정상군에서의 2년 성장량과 비교했을 때 큰 변화를 보이며 정상군의 평균치를 따라잡는 경향을 보였다. 성장 호르몬 치료는 불균형적인 성장의 징후 없이 정상화를 향한 성장(따라잡기 성장)을 나타내었으며 이는 특히 하악과두의 성장과 후안면고경의 성장을 촉진시켜 저신장 소아의 convex 한 profile을 완화하는 것으로 판단된다.

Linear Accelerator를 이용한 Stereotactic Radiosurgery

정상섭,윤도흠,오성훈,김선호,서창옥,추성실,노준규,김동익,서정호 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6

A Modified irradiation technique utilizing a linear accelerator for radiation surgery within the brain was performed in 4 patients. Three of them had brain tumors and one small arteriovenous malformation in midbrain. A Hitchcock stereotactic apparatus and a 10 MeV linear accelerator have been adapted and special computer programs for dosimetry were obtained and studied experimentally with a phantom model. Stereotactic radiosurgery is a valuable tool in the treatment of inoperable, deep seated intracranial lesions, the major advantage being high efficacy and smoothness of the procedure, as well as short hospitalization times.

저세포성 골수를 보인 환자에서 저용량 Ara-C 치료 후 급성골수성백혈병으로 진단된 1예

정승혜,박성훈,정성창,진명인,박민식,류헌모,김상경,조창호,이재련 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.1

저세포성 급성골수성백혈병은 골수 검사 결과 세포충실도가 5~40%이면서 백혈구 아세포가 30% 이상이 되는 경우를 말하며 급성백혈병 중 5~10%를 차지한다. 저세포성 급성골수성백혈병에서 low-dose Ara-C는 골수양 분화를 항진시킴으로 치료 효과를 가진다고 알려져 있다. 저자들은 저세포성 급성골수성백혈병 또는 저세포성 골수이형성증후군이 의심되어 low-dose Ara-C를 투여한 후 세포충실도의 증가를 보이며, 후에 급성골수성백혈병으로 진행하는 증례를 경험하였다. 본 증례에서는 low-dose Ara-C 투여 후 골수의 세포충실도의 증가를 확인할 수 있어 low-dose Ara-C의 분화 유도 효과를 뒷받침해 준다고 볼 수 있다. 환자는 idarubicin과 Ara-C 병용 요법으로 관해유도요법을 시행한 후 완전관해에 도달하여 공고요법 중이다. Hypocellular AML occurs in 5 to 10% of patients with AML, and has been described as a subset of AML with a cellularity between 5 and 40% when the blast % exceeds 30% of all the nucleated bone marrow (BM) cells. Low-dose cytosine arabinoside (Ara-C) in patients with hypocellular AML is known to be an effective regimen with some clinical benefits through the action of myeloid differentiation. We experienced a 56- year-old female with pancytopenia in the peripheral blood and a hypocellular marrow. She was diagnosed of having either hypocellular AML or hypocellular MDS and chemotherapy with low- dose Ara-C was started. Her BM cellularity increased to 10%. Two months later she was admitted again with thrombocytopenia with a BM cellularity of 75% and was diagnosed of AML (FAB M2). The increase in BM cellularity supported the myeloid differentiation effect of low-dose Ara-C. She achieved complete remission after receiving a combination regimen of idarubicin and Ara-C and is presently undergoing postremission therapy.

최대 등척성 수축시 표면근전도에서 근 수축 개시점 결정을 위한 기법들의 신뢰도

정이정,조상현,이정훈,이상헌 한국전문물리치료학회 2003 한국전문물리치료학회지 Vol.10 No.1

The purpose of this study was to compare the relative accuracy of a range of computer-based analysis with respect to EMG onset determined visually by an experienced examiner. Ten healthy students (6 male, 4 female) were recruited and three times randomly selected trials of isometric contraction of wrist flexion and extension were evaluated using four technique. These methods were compared which varied in terms of EMG processing, threshold value and the number of samples for which the mean must exceed the defined threshold, and beyond 7% of maximum amplitude. To identify determination of onset time, ICCs(Intraclass Correlation Coefficients) was used and inter-rater and intra-rater reliability ranged good in visually derived onset values. The results of this study present that in wrist flexion and extension, the reliability of the inter and intra-examiner muscle contraction onset times through visual analysis showed beyond .971 with ICCs. The reliability of the muscle contraction onset time decision through visual reading, tested with computer analysis, showed a relationship of all the selected analysis methods with ICCs .859 and .871. The objective computer-based analysis comparing with visual reading at the same time is the effective and qualitative data analysis method, considering the specificity of each study method.

두경부 유리피판 26례 분석

정복성,윤근철,심경보,고경석,한상훈 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.3

Twenty four patients(21 males and 3 females) aged 14 to 70 years underwent 26 microvascular free tissue transfers in head and neck reconstructions from April 1990 to July 1992 (27 months) . Nineteen cases were tumors in head and neck area, and four were acquired deformities such as burn alopecia, burn scar contracture of the neck, Romberg disease and frontal sinus infection, and one was hemifaclal microsomia. The free flaps were executed successfully in 15 upper aerodigestive tracts, in 2 scalps and 3 skull bases and in contouring and resurfacing six facial and cervical lesions. The selection of donor site was bases upon the location of defect and the volume of tissue required : the forearm free flap was used in 11 cases, the rectus abdominis in 5, the groin in 2, the jejunum in 2, the occipital scalp in one, the first toe web space in one, the latissimus dorsi in one, the serratus anterior in one, the parietotemporalis fascia in one and the omentum in one. The free tissue transfers were primarily indicated in all patients in our series and there was no flap failure. The complications were minimal and the morbidities low. A free flap in the head and neck area is not only the most expedient method of reconstruction but also either the most reliable or the only available one in some clinical situations.

유아용 조제 분유가 치태 pH에 미치는 영향에 관한 연구

정우진,이상훈,한세현 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.1

Infant formula in nursing bottle, with inappropriate feeding habits, is major factor associated with the development of nursing caries. Although each infant formula has different carbohydrate and protein composition, studies comparing cariogenic potential of many Korean-branded infant formulas are deficient. In addition, it is on the point of being difficult to evaluate the cariogenecity of milk due to development of many infant formulas. In this study, to evaluate the cariogenic potential of many infant formulas, after oral rinse with six Korean-branded infant formulas(three milk based formulas, one soy based formula and two specific formulas for infants with allergy to milk protein and with lactose intolerance) for ten adult volunteers(eight males and two females), plaque pH change was measured with In vivo/In vitro combination technique and results were as follows. 1. All six different kinds of Korean-branded commercial infant formulas dropped the plaque pH significantly(p<0.05) and at an hour after rinse, plaque pH was not recovered in most of subjects. 2. Soy based infant formula and casein-hydrolyzated infant formula containing no casein dropped the plaque pH significantly more than milk based infant formula containing casein(p<0.05). 3. In the milk protein of infant formulas, casein had more effect on buffering the pH change of the infant formula than whey protein and casein-hydrolyzated infant formula had a refuced effect of casein. 4. In infant formulas with similar protien composition, infant formula containing sucrose dropped plaque pH more than infant formula containing lactose, but there was no significant difference(p>0.05).

Sucralfate와 Guaiazulene이 편도적출술 후 치유 과정에 미치는 영향

정윤영,김성훈,김장묵 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1

Tonsillectomy may result in severe sore throat, otalgia, trismus and postoperative bleeding untill the inflamed and exposed muscle becomes covered with regeneratd mucosa. Sucralfate binds with the fibrous exudate of duodenal ulcers, forming a protective barrier that promotes healing. Guaiazulene inhibits histamine release and has strong antinflammatory action. Authors analyzed 90 patients who were treated with placebo, sucralfate and guaiazulene to evaluate modification of post-tonsillectomy pain and general strength return after tonsillectomy. The obtained results were as follows; 1) In trismus, fever and weight loss, there were no statistical significance. 2) Sucralfate and guaiazulene had the significant improvement of the oral intake, the sore throat and general strength retum statistically. But there was no difference between sucralfate and guaiazulene. Therefore, sucralfate and guaiazulene is a safe and well-tolerated topical agent that offers significant pain reduction and may promote healing in tonsillectomy patients.