최근 10년간 원광의대병원에서 시행한 소아 심장혈관 수술의 임상적 고찰

윤향석,정수미,최두영,오광수,오연균,김종덕,양현웅,이삼윤,김형곤,최종범,최순호,노병석 圓光大學校 醫科學硏究所 1995 圓光醫科學 Vol.11 No.2

We reviewed 10 years experiences of the clinical aspects and early postoperative results in 544 pediatric patients(age less than 16 years old). Among them. 529 cases had the congenital heart diseases, and 15 had the acquired diseases. Open heart surgery was performed in 413 patients. 115 cases were treated with non-open heart surgery. 16 with interventional catheterization. Annual increase of the cardiac patients was not significant in recent 10 years, except slight increase in 1994. The mean age of the study patients had been evidently changed to younger year by year. Total mortality rate of the open heart surgery was 6.4%. The cyanotic congenital heart diseases were high in early postoperative mortality by 25.7%, whereas 4% in acyanotic group. The age group less than one month was most highest in surgical mortality(66.7%). There were no deaths in patients with patent ductus arteriosus(103 cases), atrial septal defect(83 cases) or pulmonary stenosis(17 cases). Among 220 patients with ventricular septal defects(VSD). 10(4.5%) were died early postoperatively. In cyanotic group, the patients with pulmonary atresia with ventricular septal defects(PAVSD), transposition of the great arteries(TGA), interrupted aortic arch(IAA), complex cardiac anomalies with isomerism seemed to be most susceptible to an early death.

신생아 이송에서의 저체온증

김향숙,정윤석,조준필,박문성,배기수 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Back Ground : Hypothermia is a condition that can lead to serious complications and even to death in newborn. Although the temperature control is essential in neonatal care, it is often neglected during urgent transfer from local private hospitals. The purpose of this study is to evaluate the incidence and clinical outcomes of transfer induced neonatal hypothermia. Subjects and Method : In this retrospective study, subject is limited to transferred outborn babies with age less than 27 hours from June 1996 to May 1999. A total of 3,086 patients were admitted in NICU during the study period and inborn and outborn babies were 1,743(56%) and 1,343(44%) respectively. Among the 1,343 outborn babies, 212 babies were transferred from the private hospital within 24 hours of birth and were eligible for the study. Rectal temperature on arrival, transfer time, birth weight, gestational age, initial arterial gas study, and clinical outcome were compared. Statistical analysis has been done with chi-sqaure test and multiple logistic regression analysis. Results : There were 84 cases(39.6%) hypothermia(<36℃) among the 212 babies and the rate of hypothermia in transfered babies have not decreased over the study period. There were significantly more hypothermia in lower gestational age (less than 28 weeks) and lower birth weight (less than 2,000gm) caused hypothermia significantly more than normal gestational age or normal range of birth weight. And time interval (less than 12 hour) from birth to arrival at emergency department was also significant factor in hypothermia. The mortality rate was three fold higher in hypothermia than normothermic or hyperthermic babies. Conclusion: This study shows that hypothermia during neonate transportation is a major cause of neonatal mortality and morbidity in prehopital care. Body temperature control during transport of neonates under 24 hours of age should be emphasized for the better outcome of treatment.

응급실로 내원한 급성 호중구 감소성 소장 결장염(Typhlitis) 1례

김향숙,정윤석,조준필 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Typhlitis or neutropenic enterocolitis is a life-threatening, necrotizing process of the cecum whose incidence is increasing. Typhlitis presents as fever, abdominal pain, and diarrhea in neutropenic patients. As the incidence of typhlitis increases, emergency physicians must be aware of this rapidly progressive and potentially fatal disease. The definitive management of typhlitis is controversial. The most prudent course for the emergency physician is to initiate aggressive medical management early in the ED. We describe a 25-year-old man with severe neutropenia presented to the emergency department with fever, abdominal pain, diarrhea that began 2days earlier. Abdominal computerized tomography(CT) demonstrated diffuse concentric thickening of the cecal wall, intramural edema, inflammatory bowel changes but no free air and abscess formation. He was recovered by early diagnosis and aggressive medical therapy. We report a case of typhlitis with literature reviews.

말기 신부전 환자에서 투여 경로에 따른 유전자 재조합 인 Erythropoietin(Epokine^(�))의 효과와 안정성에 대한 연구 : 제 4상 연구 A Phase 4 Single Center Study

송현용,윤향숙,강신욱,최규헌,하성규,이호영,한대석 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

목 적 : 국내 독자적 기술로 첫 개발된 유전자 재조합 인 에리트로포에틴(Epokineⓡ)의 투여방법에 따른 유효성과 안정성을 알아보고자 하였다. 방 법 : Epokineⓡ을 주당 100-150 U/kg, 주 2회, 12주간 피하 주사하여 목표 또는 안정된 혈색소치 유지 후 무작위로 피하 및 정맥 주사군으로 나누어 12주간 혈액투석 및 복막투석 환자13명, 28명에서 유효성, 안정성을 분석하였다. 결 과 : 양군에서 혈색소치와 헤마토크릿은 Epokineⓡ 투여 2주 후부터 증가, 혈색소치가 혈액투석 환자는 투여 전 7.3 g/dL, 투여 12주 9.5 g/dL, 24주 10.6 g/dL로, 복막투석 환자는 6.8g/dL에서 12주 10.2 g/dL, 24주 10.8 g/dL로 증가하였다. 양군에서 교정 망상적혈구수(%)는투여 1주 후부터 전 기간동안 증가하였다. 혈청 내 철분, ferritin치는 양군에서 투여 2주 후부터감소, 총 철분 결합능은 투여 2주 후부터 증가하였다. 12주째 혈액투석 환자에서 많은 Epokineⓡ용량이 필요했으나(142.2±20.5 vs 117.3±33.6 U/kg/wk, p<0.001) 24주 후 양군의 용량차이는 없었다(123.6±41.5 vs 99.2±49.3 U/kg/wk, p>0.05). 혈액투석 환자에서 피하 주사가Epokineⓡ 투여용량이 더 적었으나(97.4±15.4 vs 145.4±2.9 U/kg/wk, p<0.002) 복막투석 환자는 차이가 없었다(93.0±60.2 vs 105.4±9.7 U/kg/wk, p>0.05) 연구기간 중 9명(18.8%)에서혈압강하제 추가가 필요한 혈압상승, 근육통 동반 상기도 감염 유사증상 및 두통 등의 부작용이 있었다. 대부분 자연소실 혹은 대증요법으로 치유되었고 2명이 부작용으로 탈락하였다. 결 론 : 말기 신부전 환자의 빈혈 개선에 사용하는 Epokineⓡ의 효과는 복막투석 환자에서 더 좋았으며 투여 경로는 정맥주사보다 피하주사가 높음을 알 수 있었다. Background : We evaluated the clinical efficacy and safety of recombinant human erythropoietin(Epokine^(ⓡ)). Methods : A comparative prospective study of intravenously and subcutaneously administrated Epokine^(ⓡ) conducted 13 patients performing hemodialysis and 28 patients performing continuous ambulatory peritoneal dialysis with end-stage renal disease. Epokine^(ⓡ) was given initially at a dosage of 100 unit/kg, subcutaneously, two times a week. The patients had achieved stable or more than 10 g/dL of hemoglobin level for 12 weeks and then we randomized switching intravenously or subcutaneously administrated Epokine^(ⓡ) for another 12 weeks. Results : Hemoglobin(g/dL) and hematocrit(%) increased significantly from baseline levels beginning from 2 weeks after Epokine^(ⓡ) administration. In HD patients, hemoglobin increased significantly from 7.3 to 9.5 after 12 weeks and to 10.6 after 24 weeks. In CAPD patients, hemoglobin increased significantly from 6.8 to 10.2 after 12 weeks and then 10.8 after 24 weeks(p<0.05). Corrected reticulocyte count(%) was significantly increased from baseline levels beginning from 1 week after Epokine^(ⓡ) administration and continuously increased during study period in both group. Serum ferritin and serum iron decreased significantly and total iron binding capacity increased significantly after 2 weeks. At 12 weeks, HD patients were significantly needed more dosage of Epokine^(ⓡ) than CAPD patients(142.2±20.5 vs 117.3±33.6 U/kg/wk, p<0.001), but at 24 weeks, the dosage was not different(123.6±41.5 vs 99.2±49.3 U/kg/wk, p> 0.05). In HD patients, intravenously administrated Epokine^(ⓡ) group was more dosage than subcutaneously group(97.4±15.4 vs 145.4±2.9 U/kg/wk, p< 0.002), but CAPD patients were not different by administration method(93.0±60.2 vs 105.4±9.7 U/kg/ wk, p>0.05). The 9 cases(18.8%) were suffered from headache and flu-like syndrome, but these side effects were not severe and disappeared from conventional therapy. Conclusion : Epokine^(ⓡ) administration is safe and effective in treating anemia of ESRD patients and subcutaneously administration is significantly more effective than intravenously. (Korean J Nephrol 2002;21(2):190-198)

냉이의 채취 시기 및 지역에 따른 풍미성분

이미순,윤석권,최향숙 덕성여자대학교 식물자원연구소 1993 植物資源硏究誌 Vol.1 No.-

냉이를 대상으로 채취시기 및 토양의 비옥도에 따른 휘발성 풍미성분 변화패턴을 조사한 결과 동일 지역에서 채취한 시료라도 채취시기에 따라 휘발성 풍미성분 저상에 차이가 있음을 확인하였다. 마석 지역에서 3월에 채취한 냉이에서는 총 50종의 성분이, 4월에 채집된 냉이에서는 총 58종의 성분이 확인되었다. 구성 성분의 차이이외에 같은 성분이라도 양적인 측면에서 상이하였다. 야생식물의 휘발성 풍미성분의 조성 및 함량의 차이는 일조량, 강우량 및 기온 등의 여러 가지 환경요인에 의한다고 측정되며, 이러한 환경요인에 대해서는 앞으로 계속 규면되어야 할 것이다. 토양의 비옥도에 따른 휘발성 풍미성분의 변화패턴을 조사하기 위하여 강원도 춘천 지역에서 토양의 질이 좋은 밭과 일반 들판에서 같은 시기에 채취한 냉이를 분석한 결과 휘발성 풍미성분의 profile이 다를 뿐만 아니라 들판에서 채취한 냉이에서는 19종의 휘발성 풍미성분이 더 확인되었다. 냉이를 대상으로 채취시기 및 채취지역에 따른 유리 및 전 아미노산의 함량을 조사한 결과 양적인 측면에서 큰 차이를 보였으며, 강원도 춘천의 토양이 비옥한 밭에서 채취한 시료가 일반 들판에서 채취된 냉이에 비하여 유리 및 아미노산의 함량이 월등히 높았다. These studies were performed in order to determine the volatile flavor components and contents of amino acids in total and free forms from Capsella bursa-pastoris. Volatile flavor components from Nangi (냉이 ; Capsella bursa-pastoris) were collected by simultaneous steam distillation-extraction(SDE) method. Essential oils were analyzed by gas chromatography(GC) and combined gas chromatography-mass spectrometry(GC-MS). Amino acids were identified and quantified by automatic amino acid analyzer. Emphasis was given to the effects of collecting time and growing regions on flavor components from this wild plant. As a result of confirming essential oils of Capsella bursa-pastoris collected from MaSeok region in early spring(March) and middle spring(April), the kinds and amounts of volatile flavor components revealed different patterns depending upon collecting time. Respective 50 and 58 volatile flavor components were confirmed in samples of Capsella bursa-pastoris collected in early spring and middle spring. Samples of Capsella bursa-pastoris collected from open field in ChunCheon region showed a greater number of volatile flavor components than the ones collected from ordinary field. Sixteen kinds of amino acids were identified and quantified, that is aspartic acid, threonine, serine, glutamic acid glycine, alanine, valine, methionine, isoleucine, leucine, tyrosine, phenylalanine, lysine, histidine, arginine and proline, Fifteen kinds of free were identified. Capsella bursa-pastoris collected from ordinary field in ChunCheon region contained larger amounts of total and free amino acids than any other samples. The amounts of total and free amino acids revealed different patterns depending upon collecting time and growing regions.

영아의 선천성심질환에 대한 개심술후의 집중치료에서 복막투석용 도관삽입의 의의

오재화,윤향석 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.2

Background: We reviewed 5 years' experience with peritoneal drainage(PDr) in infants who underwent open heart surgery. The aim of this study was to investigate the effect of PDr on fluid balance and several parameters of intensive care. We hypothesized that PDr is safe and effective in infants with low-output cardiac failure after cardiac operations. Methods: Six(3.3%) of 60 consecutive infants who underwent open heart surgery required peritoneal dialysis(PD) during the PDr. Simple PDr was performed in remaining 54 infants. The silicone rubber PD catheter was inserted into the center of abdominal cavity just after the operation, and the subsequent PDr was maintained during the intensive care. Results: Early postoperative mortality in all in infants with congenital heart disease was 1.6%. Total amount of intake was 6.30±1.59 ㎖/㎏/hr, and total output was 6.95±2.32 ㎖/㎏/hr, urine output was 5.08±2.55 ㎖/㎏/hr, pleural fluid 0.78±0.52 ㎖/㎏/hr, peritoneal fluid 1.20±0.90 ㎖/㎏/hr. The ratio of the output to the intake(O/I) was 1.1. None of the complications required early termination of the drainage. Hemodynamics and pulmonary function were maintained steadily during the postoperative intensive care. Conclusions: The early institution of peritoneal drainage(PDr) in infants with congenital heart disease after cardiac operations not only removes fluid, thus easing fluid restriction, but may also improve cardiopulmonary function.

Duct-Occlud를 이용한 동맥관개존의 비수술적 폐쇄

오만택,오재화,윤향석 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.2

Background: We tried to occlude the duct with retrievable coil device(Duct-Occlud) in 6 children with patent ductus arteriosus(PDA). And, we reviewed the technical aspects and the short-term results. Methods: PDA occlusion with "Duct-Occlud" system was attempted in 6 patients with small to moderate size PDA from January 1999 to November 1999. Mean age of the patients was 6.56 (1.33 to 14)year. After estimation of the size of PDA, retrievable coil device(Duct-Occlud) was inserted through the femoral vein route. The angiocardiography was performed 10 minutes after the procedure. On next day and one week later, the follow-up echocardiogaphy was checked. And then, it repeated at 3 months, 6 months later. The follow-up duration was 5.5(1 to 11) months. Results: The Qp/Qs was 1.44(1.25 to 1.63), Rp/Rs 0.09(0.03 to 0.15), size of pulmonary end 2.73(2.1 to 3.5)㎜, aortic end 4.58(2.8 to 5.5)㎜, length 5.83(3.8 to 8)㎜. The complication of the procedure occurred in one patient by uneventful earlier detatchment. Flow disturbance was not developed. Conclusions: Coil occlusion with the Duct-Occlud system is a safe and effective method for percutaneous closure of small to moderate-size PDAs. Larger numbers of treated patients and longer follow-up period would be necessary to more precisely define the efficacy, and most appropriate indications for this system.

재발성 가와사끼병의 임상양상과 검사소견

유승택,최은정,이창우,오연균,박승택,윤향석 圓光大學校 醫科學硏究所 2003 圓光醫科學 Vol.18 No.2

만성 재발성 소아 흉통의 원인 질환과 임상양상

최은정,이은아,이창우,최두영,오연균,김종덕,윤향석 대한소아과학회 2004 小兒科 Vol.47 No.6

감염병 대유행(코로나-19) 시대의 비대면 집단상담 사례연구 : 교사들의 직무 스트레스를 중심으로

윤향숙(Hyang-Suk YOON),고희경(Hee-Kyung KO),장성화(Sung-Hwa JANG),김신권(Shin-Kwon KIM) 한국상담심리교육복지학회 2021 상담심리교육복지 Vol.8 No.3

이 연구는 2019년부터 시작된 COVID-19라는 감염병 시대의 비대면 집단상담 사례연구로 교사들의 직무 스트레스 대처에 대한 효과성과 가능성을 살펴보는데 목적이 있다. 최근 감염병 대유행으로 인한 사회적인 거리두기, 집합금지 등의 조치가 육체적, 정신적 고립을 만들고 이에 따르는 우울과 불안이라는 정신건강의 위기를 초래하는 상황에서 사회적 단절의 문제점을 해결하기 위한 여러 가지 방법이 요청되고 있다. 그 가운데 감염의 위험을 최소화 하는 비대면 집단상담이 정신건강과 감염병의 문제를 함께 대처하는 중요한 상담 방식으로 인식되고 있다. 이 연구는 비대면이라는 특정한 환경과 줌(zoom)이라는 플랫폼을 통해 교사대상의 집단상담을 진행하였다. 심리검사와 교사들의 주관적 평가를 종합적으로 고려하였을 때, 이 집단에게서 비대면 집단상담의 효과를 확인할 수 있었다. 이 결과를 바탕으로 감염병 대유행 시대에 비대면 집단상담이 가지는 의의와 후속 연구를 위한 방안을 제안하였다. The purpose of this research is to examine practical efficacy of online group psychotherapies that were conducted for school teachers who were suffering from rapid increase of work stress level by the COVID-19 that broke out in 2019. The pandemic has influenced the mental health of general public by imposing strict social-distancing policies for preventing the epidemic, which makes people suffer from significant levels of depression and anxiety issues. Therefore, the practice of online group psychotherapy is requested to help people who are experiencing mental issues caused by social isolation without worries of contagion. This research investigates the possibilities of online group psychotherapy by focusing on psychological tests and personal evaluations of participants who had to encounter a particular online platform(zoom) that made group psychotherapy sessions without physical contact. As a result, the research confirms effectiveness of the online group therapy and suggests the practical ways in which further researches can be conducted.