비외상성 소장천공

신언성,유완식,황일우 慶北大學校 醫科大學 1986 慶北醫大誌 Vol.27 No.4

저자들은 1976년부터 1985년까지 만 10년간 경북대학교 의과대학 외과학교실에서 경험한 비외상성 소장천공 환자 85예를 대상으로 발병원인, 진단방법, 치료결과에 대해서 분석한 결과를 요약하면 다음과 같다. 소장천공의 원인별로는 장티프스가 64예, 장결핵이 8예, 장폐쇄가 5예, 중피종이 1예, 원인불명이 7예 이었고 수술전 진단이 정확했던 경우는 장티프스가 93.8%, 장결핵이 37.5%, 장폐쇄가 60% 이었다. 장티프스의 경우에 Widal 반응의 양성율은 발열후 제 4주째가 제일 높았고, 혈액배양에서 Salmonella균의 양성율은 제 2주째가 제일 높았으며, 병리조직 검사에서는 거의 비슷한 양성율을 나타내었다. 합병증의 발생빈도는 장폐쇄의 경우 80%, 장티프스의 경우 48.4%, 장결핵의 경우 12.5%로 원인질환에 따라서 차이를 나타내었고, 복강내 오염이 심할때의 합병증 발생빈도는 63.2%, 중등도 일때는 54.8% 경할 때는 31.4%로 나타나서 유의한 차이를 나타내었다. 천공부위를 단순봉합 했을 경우 합병증은 44.9%에서 발생하였고 절제후 단단문합술을 실시했을 경우는 52.9%에서 발생하여 유의한 차이는 없었다. We had managed 85 cases of the nontraumatic small intestinal perforations during the 10 year period from 1976 through 1985 at the Department of Surgery, Kyungpook National University Hospital. There were 64 cases of typhoid fever, 8 cases of tuberculous enteritis, 5 cases of intestinal obstruction, and one case of mesothelioma as the underlying cause of the small intestinal perforation. The correct preoperative diagnosis of the underlying cause was established in 93.8% of typhoid fever, 60% of intestinal obstruction, and 37.5% of tuberculous enteritis. Of the patients with the typhoid fever, the highest positive rate of the Widal reaction was reported in the fourth week of the disease, and the blood culture for Salmonella typhi in the second week of the disease. The morbidity of the patients with intestinal obstruction was 80%, typhoid fever 48.4%, tuberculous enteritis 12.5%. The morbidity was 31.4% in patients with minimal peritoneal contamination, 54.8% with moderate contamination, 63.2% with severe contamination. This difference was statistically significant. The morbidity according to the types of the operation was not significantly different.

綜合病院에 入院한 結核性腦膜炎 患兒의 疫學的 觀察

尹聖道,李性寬 慶北大學校 醫科大學 1981 慶北醫大誌 Vol.22 No.1

大邱市內 三大綜合病院에 1975年부터 1980年까지 6年間 小兒科에 入院한 結核性腦膜炎 患兒 253名에 대한 疫學的調査分析 結果는 다음과 같다. 結核性腦膜炎의 發生率은 男兒가 女兒보다 높고, 3세以下의 年少兒에서 高率이었고, 年度別로는 1975年을 起點으로 했을때 漸次減少하였으며, 季節的으로는 春季가 가장높고 秋季가 낮았다. 地域別로는 大都市外廓地가 가장높고, 다음이 農村, 中都市, 大邱市中心都의 順位였다. 出生順位別로는 끝아이에서 높고, 中間아이에서 低率이었다. 結核家族에서 發生率이 높았고 BCG未接種者에서 높았다. 發病에서 入院까지의 期間은 中期以後가 많고 症狀으로는 末期인 意識混濁을 同伴하는 患兒가 많았다. 症狀別로는 熱, 嘔吐, 痙攣, 意識不明등이 높게 나타났으며 治療期間은 7日以後가 34%, 8日에서 20日까지가 31%, 20日이후가 24%였다. 退院時의 治療成積은 漸定的인 退院當時 狀態에서 症狀이나 腦脊髓膜液性狀의 狀況으로 判定하여 好轉한 것이 51.7%, 惡化가 36.9%, 死亡이 11.4%이었다. 好轉率은 男兒가 女兒보다 高率이었고 年齡的으로는 年少兒가 年長兒보다 높았으며, 年度別로는 1975年을 起點으로 했을때 年度가 經過함에 따라 好轉率이 높았고, 季節的으로는 夏節에서 높았고, 地域的으로는 都市의 中心地는 높으나 外廓地는 가장 低率이었다. 出生順位別로는 中間아이에서 높고 첫아이에서 가장 낮았다. 傳染源이 있는 患兒에서 높았고, BCG接種兒에서 높았다. BCG와 傳染源이 같이 있는 BCG 群에서 高率이었고, 傳染源은 있으나 BCG 接種이 없는兒에서 가장 낮았다. 症狀別로는 意識混濁群이 가장 낮았고 頭痛郡이 가장 높았다. 發病해서 入院까지의 期間이 짧을수록 그리고 入院期間이 길수록 好轉率이 높았다. 끝으로 적극 협조해주신 慶北大學敎醫科大學 부속병원 소아과교실원, 계명대의과대학 소아과 교실원 및 파티마병원 소아과원 제위에게 심심한 감사를 표시하는 바이다. During the last 6 years since 1975, epidemiological studies were done on 253 children with tuberculous meningitis admitted in 3 general hospitals in Daegu. The result were as follows; 1) The statistical studies indicated a gradual decrease in the incidence after 1975. Concerning the age difference, the highest incidence was noticed in the group of the children under 3 years old, rate of the group was 57.3% of the total patients. Concerning sex differences, the incidence of the male patients were slightly higher than that of the female patients. Concerning the seasonal differences, its incidence in spring was found to be the highest. Concerning the areas, the incidence in the suburban area was highest and rural, middle urban and central area in the large city were followed. Concerning the birth order, the incidence was higher in last child than in first and middle child. The source of the infection was mainly familial and inicidence of the group with infectious source accounted for 36.5%. The incidence of the group inoculated BCG accounted for 39.1% of the total patients. The main chief complaints were drowsiness, convulsion, vomiting, headache and fever. Main complications of the disease were miliary tuberculosis, 17.0%, pulmonary tuberculosis, 9.5%, other tuberculous lesion, 2.0% and other diseases, 6.0%, respectively. Concerning duration between initial onset and admission within 10 days, 11-20 days and after 20days were 36.8%, 40% and 20.6%, respectively. Concerning duration of treatment were within 5days, 6-10days, 11-20days and more than 30days were 31.0%, 15.0%, 42.0% and 12%, respectively. 2) The prognosis of the diseases was analysed by various factors. Concerning the age difference, the patients less than 3 years old showed low rate of improvement and the rate of improvement increased with increase of ages. Concerning sex difference, the rate of improvement was slightly higher were in male than female cases. Concerning calendar year, the rate of the improvement was increased year by year. Concerning seasonal difference, the rate of the improvement was the highest in summer and autumn, winter and spring in that order. Concerning birth order, the rate of the improvement was highest in middle child and last and first child were in that order. The rate of the improvement were higher in the patients with infectious source than in those without sources and in the group of BCG vaccination than in that of non-vaccination. Concerning relationship between the rate of improvement and the history of infectious source and BCG vaccination, it was found that its rate of the patient with infectious source and BCG vaccination was highest paradoxically and the patient with infectious source and non-vaccination was lowest. Concerning the duration between initial onset and admission, the rate of improvement was higher in shorter period than that of longer period. Concerning the duration of the treatment, the rate of improvement was higher in the patients received longer period than that of shorter period. The rate of improvement was 35.1% in the group of the patients who showed disturbance in the consciousness already on the admission, while the group with headache was the highest rate with 73.7%.

大邱地域社會에서의 精神醫學에 對한 態度의 變化

尹錫夏 慶北大學校 醫科大學 1975 慶北醫大誌 Vol.16 No.1

1970年부터 1975年까지 5年間 慶北醫大病院의 一般醫師 看護員 및 大邱市內에 居住하는 一般人을 對象으 로 이들의 精神疾患과 精神科에 對한 態度의 變化를 알아 보았다. 調査方法은 1) 精神病의 原因, 治療, 豫後 2) 精神病患者에 對한 偏見과 拒否 3) 神經症과 精神生理障碍 및 精神治療 4) 精神科, 精神科醫師, 精神科病棟 等 모두 20項目의 選多式으로 된 設問紙를 使用했다. 이 質問紙로 1970年 3月에 慶北醫大病院의 醫師 看護員 84名과 市內에 居住하는 一般人 143名에게 調査 를 實施하고, 같은 質問紙를 사용하여 1975年에 慶北醫大病院의 醫師 看護員 78名과 一般人 475名을 對 象으로 調査하였다. 一般人은 1970年의 調査對象者와 年齡, 敎育程度, 職業等의 條件이 같은 143名을 1975년의 應答者中에서 選擇하여 比較하였고 醫師 看護員은 年齡, 敎育程度가 거의 同一하다고 보고 그 대로 1970年 調査와 1975年 調査 成績을 統計的으로 比較하였던 바 아래와 같은 몇 가지의 事實을 發見 하였다. 1970년 조사와 1975년 조사를 비교할 때 1. 醫師 看護員群에서 1. 變化가 없는 것은 1) 精神疾患의 原因과 精神病의 精神科的 治療에 對해서는 80% 以上이 올바른 知識을 가지고 있고 2) 80% 以上이 如前히 精神病疾患을 앓았던 사람이면 가까운 關係를 맺기를 꺼려하고 있다. 3) 約 半數의 應答者들은 여전히 精神病患者는 대부분 위험하다고 믿고 있으며 精神科病棟의 開放을 찬 성하는 者들은 30% 程度에 不過하다. 4) 醫師 看護員의 半程度는 綜合病院에서 精神科病棟을 獨立된 建物에 分離시키길 바라고 있다. 2. 變化를 보인 것은 1) 精神科病棟의 全的 開放에는 反對者가 아직많으나 精神病患者에게 보다 人道的이고 自由로운 入院에 찬성하는 者가 增加했으며 2) 精神病을 앓았던 사람이라도 皮相的 關係에서는 그들을 社會的으로 받아드리려는 者가 많아졌고 3) 精神病의 豫後에 대해서는 悲觀的 態度를 나타낸 者가 增加하였고 4) 精經病의 治療는 精神科에서 精神治療를 받는것이라는데 찬성하는 者는 줄고 "수양"이 좋다는 應答者 가 增加하였다. 5) 精神科醫師들에 對한 好意的 態度가 적어지고 그들의 分析的 態度에 不快하다는 態度를 가진者가 增 加하였다. 2. 一般人가운데서 1. 變化가 없는 것은 1) 應答者의 約 1/2이 如前히 精神疾患의 原因과 治療에 대하여 잘 알고 있지못하며 2) 約 30%는 神經症의 治療에 관해서도 알고 있지 못하고 3) 精神病이 모두 위험할 것이라는 態度를 보인 者가 如前히 過半數를 차지하며 4) 70% 以上은 精神生理障碍의 槪念에 對하여 多少 알고 있다. 2. 有意한 變化는 醫師 看護員들과 마찬가지로 精神疾患者들에 대한 보다 人道的 入院方法을 支持하는 者와, 깊은 關係가 아니라면 精神病을 앓은 者라도 社會的으로 받아드리려는 者들이 많아졌다. 그러나 醫師看護員들과는 달리 1) 精神治療의 效果와 精神病의 회복 정도에 對한 期待에서 肯定的인 者가 많아졌고 2) 神經症의 原因에 關해 올바르게 알고 있는 者는 줄어든 反面 "精經의 病"으로 誤解하는 者가 많아졌 고 3) 精神病을 모두 위험시하는 者와 가까운 관계를 꺼려하는 者들이 增加하였다. (本硏究를 하는데 여러가지로 도와주신 高麗神經精神科醫院의 金政輝 先生과 慶北醫大病院 腦波檢査室의 林美淑孃에게 심심한 감사를 드린다.) In order to implement the better care for the mentally ill and to promote mental health in general at the given community, it is utmost important to understand the attitude of the general public as well as medical professionals toward psychiatry. In the recent years, it is vaguely believed that the attitude about psychiatry has been much accepted than ever before, however, no systematic research has been done to confirm on the subject. This study is done to compare how the attitude has been changed over the past five years, from 1970 to 1975. In the year of 1970, we had conducted the study to analyze the general attitude about psychiatry by using the the questionaire form of multiple choice. The data were obtained from the random sampling of the staff at Kyungpook University Hospital and the general public in Taegu city. In 1975, five years later, we conducted the same study to compare with the previous findings by using the same questionaire form. Though the samples were not the same as the previous one, we tried to match sex, age and education accordingly. The summary of the study is made as follows: A) Among the medical professionals 1) No significant changes in attitude were noted in the following items: a) More than 80% showed a positive view on the prospect of mental illness. b) More than 80% were still reluctant to have an intimate relation with the mentally ill. c) About half of the respondents saw the mentally ill unpredictable and dangerous, and only 30% favored on the open ward system. d) In the general hospital setting, half of them were in favor of separating the psychiatric ward. 2) Significant changes in attitude were noted in the following items: a) Though they were against opening the psychiatric ward, the increasing trend was exprssed that the mentally ill should be handled more humanistically. b) They became more acceptable toward the mental patients, however, at a superficial level though. c) They became more pessimistic about the prognosis of the psychotic patient. d) The increasing numbers had showed the "rest" would be a preferable treatment for the neurotics. e) Psychiatrists were viewed lesser humanistic and their assumed analytic eyes made the respondent quite uncomfortable. B) Among the general public No significant changes: a) About half of them were still poorly informed about the etiology and treatment of the mental illness. b) About 30% had still held a misconcept on the treatment of neurotics. c) More than half had still seen the mentally ill unpredicatble and dangerous. d) More than 70% were well informed about the psychosomatic concept. Significant changes: Likely with medical professionals a) The increasing trend was expressed that the mentally ill should be handled more humanistically. b) They become more socially acceptable toward the mental patient. Unlikely with the medical professionals, b) They were becoming more positive about psychotherapy as well as about the prospect of psychotics. c) Those who were well informed about neurosis were decreasing in number and they tent to see it caused by the inflammation of "nerve" d) The increasing trend was noted in viewing the mentally ill as dangerous and in relutance to have an intimate relation.

大邱地方 一部 大學生들의 吸煙實態

姜福秀,芮旻海,李性寬 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.2

1980년 10월 1일부터 1개월간 경북대학교 의과대학 남학생 303명과 대구시내 일반 대학생 255명을 대상으로 흡연에 관한 실태를 조사한 성적을 요약하면 다음과 같다. 1. 총대상자 558명중 흡연학생은 339명으로 흡연율은 60.7%로 나타났고, 의대생의 경우 62.4%, 일반 대학생의 경우는 58.8%의 흡연율을 나타내었다. 흡연 중단율은 전체 19.9%이며 의대생의 경우 16.5% 일반 대학생의 겅우 23.9%로 나타났다. 2. 흡연시작 연령은 대체로 20세 전후가 65.7%로 나타났으며 18세 이전의 고교시절부터 흡연을 경험한 학생이 23%로 나타났다. 3. 흡연기간은 과반수 이상인 56.2%가 5년미만인 것으로 나타났고 그중 2년 이상 3년 미만이 22.1%로 제일 높게 나타났다. 4. 흡연량은 하루 14개피 미만을 피우는 학생이 전체 63.1%로 제일 많았으며 25개피 이상 피우는 학생은 3.3%로 나타났다. 5. 흡연과 음주와의 관계에서 흡연하는 학생중 91.7%가 술을 마시는 것으로 나타났다. 6. 흡연동기로는 37.7%에 해당하는 학생이 호기심에 의해서 흡연을 시작했으며 17.7%의 학생은 선배 친구의 권유로 담배를 처음 시작한 것으로 나타났다. 7. 장차 흡연에 대한 태도는 계속 피우겠다는 학생이 45.7%, 감량 하겠다는 학생이 42.8%, 금연하겠다는 학생이 11.8%로 나타났으며, 의대생의 경우에서 60.3%가 금연 및 감량 하겠다는 것으로 나타나 일반대학생 46.7%보다 높은 율을 보였다. 8. 금연 및 감량의 이유조사에서 80%에 해당하는 대부분의 학생이 건강상 이유로 나타났고 경제적 이유도 8.5%나 되었다. 9. 흡연과 관계되는 증상조사에서 기침, 객담, 호흡곤란을 호소하는 빈도가 비흡연군에 비해 흡연군이 더 높게 나타났으며, 만성 폐쇄성 호흡기 질환에 이환되는 빈도도 흡연군이 비흡연군보다 높은 경향을 나타 내었다. The present study was conducted to investigate smoking status on 303 medical students and 255 non-medical students in Taegu, for 1 month from October 1, 1980. The results obtained are summarized as follows; 339 students of 558 subjects, 60.7 percent smoked. The percentage of medical students smoking showed 62.4 and the percentage of non-medical students was 58.8. Regarding the age started to smoke, 67.5 percent of total smokers commenced smoking around the age of 20 and 23 percent experienced smoking before the age of 18. In the regard to the average daily number of cigarettes smoking, 63.1 percent of total smokers consumed under 14 cigarettes, 3.3 percent smoked 25 or more cigarettes a day. Alcohol consumption was closely associated with smoking. 91.7 percent of total smokers revealed drinker. The commonest motives for starting the smoking habit were curiosity and the influence of friends who already smoked(55.4%). Considering attitude toward smoking habits in the future, 54.6 percent of students said they would stop or reduce smoking. The commonest reason for stopping and reducing the smoking habit was health hazard(80%). The complaints of cough with sputum and shortness of breath revealed higher rates among smokers than among non-smokers. Smokers were more likely to suffer from chronic bronchitis compared to non-smokers.

분리병원균의 항생제에 대한 감수성

김중명,김재식,최성만,김인자,서상철,김경숙 慶北大學校 醫科大學 1983 慶北醫大誌 Vol.24 No.2

1983년 1월 초에서부터 6월 말까지 경북대학교 의과대학병원 임상병리과에서 임상 가검물로 부터 분리된 병원균중에서, Staphylococcus aureus 188주, Escherichia coli 97주, Klebsiella pneunonia 40주, Serratia marscens 42주, 및 Pseudomonas aeruginosa 56주를 가지고, penicillin G(PCG), ampicillin(ABPC), carbenicillin(CBPC), cephalothin(CET), chloramphenicol(CM), tetracycline(TC), sobramycin(TOB), amikacin(AK) 및 gentamicin(GM)에 대한 감수성 검사를 원판 희석법에 의하여 시행하여, 다음과 같은 성적을 얻었다. Stap aure.에 있어서는 CET에 대한 감수성 균주를 가장 많이 볼 수 있었고(138주, 73.4%), 내성 균주는 PCG에 대한 것이 가장 많았다.(178주, 94.7%). E. coli., Kleb. pneu., Serr, mars., 및 Pseud. aeru.에 있어서는 모두 AK에 대한 감수성 균주를 가장 많이 볼 수 있었는데(72주, 74.2%, 36주, 90; 25주, 59.5%, 30주, 53.6%), 이중에서 Kleb. pneu.에 대한 감수성 균주는 비교적으로 가장 많았다. E. coli.에 있어서 내성 균주를 가장 많이 볼 수 있는 것은, TC에 대한 것이었고(73주, 75.2%), Kleb. pneu.에 있어서 내성 균주를 가장 많이 볼 수 있는 것은 ABPC에 대한것이었으며(35주, 87.5%), Serr. mars에 있어서는 CET에 대한 것(41주, 97.6%)과 Pseud. aeru.에 있어서는, CET, CM 및 TM에 대한 것(각 53주, 94.6%)이 가장 내성균주가 많았다. 각 항생제 계열별로 그 감수성 균주를 보면, Stap.에 있어서는, 같은 β-lactam계라도 penicillin계보다는 cephalothpolin계에 더 많은 감수성 균주를 볼 수 있었고, E. coli에서는 β-lactam계, chlomy계, 및 tetracycline계보다도 aminoglycoside계에 더 많은 감수성 균주를 볼 수 있었는데, 이러한 경향은 다소의 예외는 있어도, 대체로 구람 음성 간균에서 공통적으로 볼 수 있었다. The pathogenic microorganisms were isolated from the clinical materials in the bateriological laboratory of the department of clinical pathology, Kyungpook National University Hospital from the first of January to the end of June in 1983. The microorganisms were consisted of 188 strains of Staphylococcus aureus(Stap. aure.), 97 strains of Escherichia coli(E. coli), 40 strains of Klebsiella pneumoniae(Kleb. pneu.), 42 strains of Serratia marscens(Serr. mars.), and 56 strains of Pseudomonas aeruginosa(Pseud. aeru.) with were chosen at random out of the pathogenic microorganisms to do their susceptibility test against antimicrobial agents by the disk diffusion method. The antomicrobial agents were penicillin G, (PCG), aimpcillin(ABPC), carbenicillin(CBPC), cephalothin(CET), chloramphenicol(CM), tetracycline(TC), tobramycin(TOB), amikacin(AK), and gentamicin(GM). The results of their susceptibility test were as follows; Stap. aure. were revealed the most sensitive pattern to CET(138 strains, 73.4%) and were revealed the most resistant from the PCG(178 strains, 94.7%). E. coli, Kleb. pneu., Serr. mars., and Pseud. aeru. were disclosed the most susceptible pattern to AK(72 strains, 74.2%: 36 strains, 90.0%: 25 strains, 5,.5%:30 strains, 53.6% respectively), and among these microorganism Kleb. pneu. were revealed the most sensitive one to AK. E. coli, Kleb. pneu., Serr. mars., and Pseud. aeru. were revealed the most resistant to TC(73 strains, 75.2%), CBPC(38 strains, 95.0%), CET(41 strains, 97.6%), and CET, CM, and TC(53 strains, 94.6% respectively). In stap. aure., the antimicrobial agent of the cephalothpolin series was more sensitive than the ansibiotic of the penicillin series in same series of beta-lactam cycle. In E. coli, the antimicrobial agents of aminoglycoside were more susceptible than the series of beta-lactam, chlomy, and tetracycline, such as trend were common to the most of all gram-negative bacilli tested, but there was a few exceptions.

子官頸部 上皮內癌의 微細構造

李東久 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.2

著者는 慶北大學校 醫科大學 病理學敎室에서 子官頸部上皮內癌으로 診斷된 83側의 生檢標本으로 組織學的 形態를 區分하고, 各 形態에 대한 微細構造 變化를 比較檢討한 結果를 要約하면 다음과 같다. 年齡約으로는 40代(47%)에서 가장 好發하는 傾向이었으며 30代에서도 多數가 觀察되었다. 組織學約으로 旁基底細胞型이 50.6%로 가장 많았으며 그 다음이 角化細胞型이었다. 腺浸透에 있어서는 各型別로 有意한 差異가 없었다. 그러나 白班症은 角化細胞型 및 旁基底細胞, 角化細胞混合型에서는 80%程度에서 同伴하였으나 多形態細胞型과 小細胞型에서는 全然 볼 수 없었다. 또한 이들 形態의 年齡的인 分布에도 特記할 差異가 없었다. 電子顯微鏡的으로 各型의 細胞들은 共通的으로 核邊緣의 不規則, 核小體의 肥大, 核과 細胞質比의 上昇 및 細胞間隔의 擴張 等의 所見을 보였으며, 各型의 細胞質에서 약간의 差異를 나타내었다. 卽 旁基底細胞型에서는 desmosome의 增加와 mitochondria의 變性이 뚜렷하였으며 角化細胞型에서는 細胞質 全般에 결쳐 張原線條(tonofilament)가 增加하였고 free ribosome은 polysome의 形態로 增加하여 있었다. 多形態細胞型에서는 rER이 잘 發達되어 있었으며 核周邊部에서 張原線條의 增殖을 가끔 블 수 있었다. 小細胞型의 細胞質은 매우 적었으며 free ribosome이 細胞質의 大部分을 占하고 있었다. 以上의 成績으로 보아 子宮頸部上皮內癌은 한 種類以上의 細胞에서 由來할 것으로 推測되며, 그 原因細胞는 본 實驗成續만으로 言及하기는 困難하며 더욱 硏究하여야 할 課題로 생각된다. Study was made to investigate morphological variation and possibly the nature of the carcinoma in situ of the uterine cervix, utilizing materials of Department of Pathology, Kyungpook National University School of Medicine. Eighty-three cases so diagnosed were selected for this purpose. These 83 cases of carcinoma in situ were classified into the following 5 histological groups : Parabasal, mixed parabasal-keratinizing, keratinizing, pleomorphic and small cell type. And then ulirastructural study was carried out on these 5 types to see if there is any interesting findings on electron microscopy. The results obtained through the comparison study of both light and electron microscopy of the carcinema in situ of the uterine cervix are as follows: The highest frequency rate of carcinoma in situ was found among the age group of 40-49(47%) and next high rate was found in the age group of 30-39. Histologically, the parabasal cell type was 50.6%, the highest rate, and keratinizing cell type was next. There was no particular difference in glandular involvement in any type. However, leukoplakia was associated with keratinizing type and mixed parabasal and keratinizing cell type in about 8O%. And there was no leukoplakia in the pleomorphic and small cell type. No particular age difference was noted among these histological types. Electronmicroscopically, all types of cells were commonly noted to have irregularity in nuclear margin, nucleolic hypertrophy, an increase in nucleus and cytoplasmic ratio, intercellular gaps, etc. Some difference was noted in cytoplasm of each type. There were significant increases of desmosome and degeneration of mitochondria in the parabasal cell type, an increased tonofilament in over all cytoplasm and free ribosome increased to form polysome in the keratinizing cell type. It is noted that rER was well developed and an occasional proliferation of tonofilament was seen around all large nuclei in the pleomorphic cell type. Cytoplasm in the small cell type was very scant and free ribosome was seen in most cytoplasm. The above report indicates squamous cell carcinonla in situ of the uterine cervix derives from more than one type of cell and it is very difficult to tell the origin of the cell of the carcinoma in situ. One has to await for further investigation of clarify this point.

객담내 결핵균의 조기발육 시도

김중명,김재식,김경선,이원길,김재룡,전동석,최성만,Kim, Jyung Myung 慶北大學校 醫科大學 1981 慶北醫大誌 Vol.22 No.2

보존 결핵 균주 5주를 가지고 hole slide culture 방법에 의하여 기초 실험을 하고, 이를 바탕으로 하여 객담 108례를 이 방법으로 배양하여 객담내 결핵균의 조기 발육을 시도하여 얻은 성적은 다음과 같이 요약할 수 있었다. 직접 도말 검경에서 양성인 객담15례(14.0%)중 hole slide culture 방법 및 Lowenstein-Jensen 배지에서의 배양 양성은 13례(86.7%)였으며, hole slide culture 방법에서 제 2일차에 이미 심한 균체의 신장이 있었다. 이러한 심한 균체의 신장은 균배양 양성의 가능성을 예견케 하였다. 직접 도말 검경에서 음성인 2례에서 양성 배양이 되었는데 hole slide culture 방법 제 6일차 및 제 8일차에서 심한 균체의 신장이 있었다. The five strains of Mycobacterium tuberculosis were cultured by the hole slide culture method for the basic experiment, and were inoculated on the Loewvenstein-Jensen media simultaneously. The results of the cultures of the microorganisms were all positive in the above method and on the Loewenstein-Jensen media. An early detection of Mycobacterium tuberculosis in 108 case of sputum was attempted by the hole slide culture method as like as the basic experimental test as above, and the results were obtained as follows; In 15 microscopic positive cases on the direct smears, 13 cases of them were positive culture by the hole slide culture method and also on the Loewvenstein-Jensen media, and two cases of them were negative by that method and on that media. In cases of negatives on the smears, two cases were only positive by the method and on the media. The long elongation of bacterial cell was observed on the slide of the second day culture in most of all cases, and there was increses of the number and dimension of the elongated cell on slide of the fourth day culture, and were many groups which composed of the elongated cells of mycobacteria containing granules in the cells on the slide of sixth day culture. In the slides of the eighth day and 10th day culture, the above all figures were mixed each others.

Takayasu동맥염의 임상적고찰

채성철,강승완,우언조,전재은,박의현,김기식,김윤년,김권배 慶北大學校 醫科大學 1989 慶北醫大誌 Vol.30 No.4

경북대학교병원 및 계명대학교의과대학 부속병원에 입원하였던 28례의 Takayasu동맥염환자의 임상적관찰을 하여 다음과 같은 성적을 얻었다. 1) 대상환자 28례중 남자가 7례, 여자가 21례였고, 남자의 평균연령은 44세, 여자의 평균연령은 21세, 전체환자의 평균연령은 27세였다. 2) 내원당시의 28례의 증상으로는 운동성호흡곤란(11례), 현기증(7례), 두통(7례), 무맥(4례), 전신쇠약감(3례), 시력장애(3례), 이상감각(3례), 복통(3례), 심계항진(2례), 흉통(1례)등이 있었다. 초기증상을 알 수 있었던 16례에서의 초기증상은 전신쇠약감 또는 피로감(8례), 국소동통(4례), 관절통(3례), 야간발한(3례), 흉통(3례), 발열(2례), 체중감소(2례), 식욕부진(1례)등이었다. 이들에서의 잠복기(latent period)는 42일에서 10년이상까지 다양하였다. 동반된 질환으로는 결핵이 2례, 류마티양관절염, 당뇨병, Valsalve동의 동맥류, 위점막 병변 및 사구체신염이 각각 1례씩 있었다. 3) 내원당시의 주요 이학적소견으로는 무맥(25례), 고혈압(16례), 병변부위동맥의 잡음(bruit)(12례), 울혈성심부전(11례), 고혈압성망막증(10례), 하지의 파행(8례), 폐동맥고혈압(2례) 및 대동맥판폐쇄부전과 승모판폐쇄부전(2례) 등이었다. 4) 검사실소견으로는 빈혈(10례), 혈침속도증가(22례)가 있었고, 그외 비특이적으로 CRP양성(13례중 9례), RA factor양성(13례중 3례) 및 ANA, LE세포, VDRL양성(13례중 1례)등이 있었고, Man toux검사는 시행한 11례중 3례에서 양성반응을 보였다. 심전도소견으로는 재분극이상(12례), 좌심비대소견(7례), QT간격연장(4례), 좌심방이상소견(2례) 및 심방세동, 발작성심방빈맥과 흉부유도에서의 R파의 "poor progression"(각각 1례)등이었다. 5) 동맥조영술소견은 Lupi-Herrera등의 1형이 11례, 2형이 6례, 3형이 9례 및 4형이 2례였다. 6) 치료받은 19례가운데 내과적치료를 받은 17례중 11례에서 부신피질호르몬제를, 10례에서는 항응고제를 사용하였는데, 부신피질호르몬제를 투여받은 4례에서만 혈침속도의 감소가 있었다. 그리고 고혈압치료를 위하여 경피적신동맥확장술이 7례에서, 신절제술이 1례에서 시행되었다. 7) 15례에서 추적관찰이 가능하였고, 이가운데 4례는 사망하였으며, 생존하고 있는 11례의 평균 추적관찰기간은 7개월(1.5-24개월)이었다. 사망한 4례중 3례는 심부전으로, 1례는 농흉에 의한 패혈증으로 사망하였다. Clinical observation on 28 cases of Takayasu's arteritis from Departments of Internal Medicine of Kyungpook National University and Keimyung University revealed followings: 1) Age and sex distribution: Seven cases were male and twenty one cases were female. Mean ages of male and female cases were 44 and 21 years old, respectively (range 11-66 years old). 2) Chief complaints on first presentation were dyspnea on exertion (11 cases), dizziness (7 cases), headache (7 cases), absence of pulse (3 cases), abdominal pain (3 cases), palpitation (2 cases), and chest pain (1 case). Initial systemic symptoms of 16 cases which could be recalled were generalized weakness and fatigue (8 cases), localized pain (4 cases), arthralgia (3 cases), night wsweating (3 cases), chest pain (3 cases), fever (2 cases), weight loss (2 cases), and anorexia (1 case). Latent periods of these cases were ranged from forty-two days to over 10 years. Concomittant diseases were pulmonary tuberculosis (2 cases), rheumatoid arthritis (1 case), diabetes mellitus (1 case), aneurysm of sinus of Valsalva (1 case), gastric mucosal lesion (1 case), and glomerulonephritis (1 case). 3) Among the physical findings were absence of pulse (25 cases), hypertension (16 cases), bruits over affected arteries (12 cases), congestive heart failure (11 cases), hypertensive retinopathy (10 cases), claudication of lower extremities (8 cases), pulmonary hypertension (2 cases), and aortic and mitral regurgitations (2 cases). 4) There were no specific laboratory findings. Among nonspecific findings were anemia (10 cases), increased ESR (22 cases). C-reactive protein, RA factor were positive in nine and three cases, respectively, of 13 cases tested. Antinuclear antibody, LE cell and VDRLK were positive only in a case of 13 cases tested. Mantoux test was positive in three of 11 cases tested. Electrocardiogram revealed abnormal repolarization (12 cases), findings of left ventricular hypertrophy (7 cases), prolongation of QT interval (4 cases). 5) According to angiographic findings, 11, 6, 9 and 2 cases had type 1, type 2, type 3 and type 4 of Lupi-Herrera and associates, respectively. 6) In 19 cases who were treated, 17 cases were given medical treatment of corticosteroid (11 cases) and/or oral anticoagulant (10 cases). Four cases on corticosteroid showed decrease in ESR. Percutaneous angioplasty of renal artery was performed in seven cases with hypertension, and successful in 4 cases in which blood pressures were normalized. In another hypertensive case, nephrectomy normalized blood pressure. 7) Follow-up observations were possible in 15 cases, of which 4 cases died. Average follow-up duration was seven months (range 1.5-24 mopnths). Causes of death were congestive heart failure in three cases, and pyothorax related sepsis in a case.

胃內視鏡 檢査時 患者의 反應

鄭福禮 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.2

1978年 4月 20日부터 同年 8月 7日 사이에 慶北大學校 醫科大學 附屬病院 胃鏡室에 胃內視鏡 檢査를 받으러 온 患者 200名을 對象으로 患春의 身體約, 또는 環境上의 條件 및 胃內視鏡檢査에 대한 사전 理解 등과 患者가 느끼는 苦痛 및 反應과의 關係를 檢討하여 다음과 같은 成績을 얻었다. 性別로는 女子가 男子보다 더 不安하고 또 더 苦痛을 느꼈으며 敎育程度別로는 敎育程度가 높을수록 적게 느끼는 傾向이 있었으나 有意的인 差는 없었다. 飮酒習性과 느끼는 著痛 사이에는 별 關聯性이 없었고 腎內視鏡檢査에 대해 事前 情報를 들은 일이 있는 群이 苦痛을 적게 느꼈고, 이 檢査에 대해 不安을 많이 느낄수록 더 若痛을 느꼈으며 患者의 體格과 느끼는 苦痛과의 사이에는 別 關聯性이 없었다. 檢査直後 檢査所感은 敎育程度가 높을수록, 診察頻度가 낮을수록, 不安感을 적게 느낄수륵 檢査를 잘해 보았다고 辰應하였다. 患者의 脈搏, 呼吸, 血壓은 檢査가 進行될수록 上昇하고 있었다. 入院患者의 경우 外來患者의 경우보다 檢査에 대한 看護員의 事前敎育이 잘되어 었었고, 不安感도 入院患者에서 적게 느끼는 傾向이 었었다. The purpose of this study was to investigate the degree of pain, anxious feeling, and changes in vital signs of patients in the course of gastroduodenofiberscopy and to discuss their reactions in connection with their personal back grounds, particularly their sex, ages, level of education. Two hundred patients were interviewed, and their vital signs were checked three times in the process of the examinations. This study was conducted from April, 20, 1978. to August 7, 1978. No significant results were noted in relation to ages and educational backgrounds. Most of the patients felt very anxious and experienced pain. The female patients reported more pain and were more anxious because of examinations than the male patients. The more anxious the patient felt, the greater the pain. The well-informed patients felt less than the uninformed patients. The inpatients were bettr informed than the outpatients. Vital signs of all patients were considerably increased just before and directly after the examination than just before the pretreatment for endoscopy. Most of the patients replied that they were satisfied to have the oppotunity to receive this examination.

원내감염과 그 균의 약제내성

이창,김중명,김재식 慶北大學校 醫科大學 1986 慶北醫大誌 Vol.27 No.4

1985년 1월부터 동년 12월까지 경북대학교 의과대학 부속병원에 입원한 9,116명의 환자를 대상으로 Study of Efficacy of Nosocomial Infection Control(SENIC)-project Ⅲ의 algorithm for dia-gnosing infection의 방법으로 조사하여 그 성적을 다음과 같이 요약할 수 있었다. 원내감염율은 4.8%이고, 그 건수비는 5.8이었으며, 요로감염증이 41.6%으로 가장 많았으며, 창상감염(37.6%), 폐렴(14.6%), 패혈증(6.2%) 순이었다. 수술환자의 원내감염율은 6.7%이었고, 수술환자에서는 창상감염이, 비수술환자에서는 요로감염증이 매우 많았다. 남여별 원내감염비는 2.4(남 ; 309, 여 ; 130)이었는데 남자에서는 창상감염이, 여자에서는 요로감염증이 더욱 많았다. 원내감염은 내과계 영역(1.9%)보다는 외과계 영역(7.0%)이 훨씬 많았으며, 외과계 영역에서는 정형외과가 가장 많았고(18.1%), 다음이 성형외과(11.6%), 신경외과(11.5%)등의 순서였고, 내과계 영역에서는 내과에서 가장 많았다. 감염 증후별로는 정형외과와 일반외과는 창상감염이, 신경외과는 요로감염증 등이 많았다. 도뇨관 사용의 경우 원내감염의 발생은 비사용의 경우보다 3배 가까이 많았고 특히 요로감염증이 가장 많았으며, 또 기존질환이 있는 경우에 원내감염의 발생을 그 질환별로 보면 화상(30.3%)과 만성 신부전증(22.9%)이 가장 많았다. 원내감염의 원인균 549주 중 Pseudomonas Sp. 119주, Escherichia coli 73주, Acineobacter calcoaceticus 73주, Enterobacter Sp. 43주, Serratia marcescens 41주, Proteus Sp. 23주, Klebsiella Sp. 15주, Citrobacter Sp. 8주, Staphylococcus aureus 50주, Enterococcus 39주, Staphylococcus albus 23주, β-hemolytic Streptococcus 23주, Candida Sp. 15주, Aspergillus fumigatus 4주였다. gram 음성에 속하는 원내감염균의 항생제에 대한 내성획득율 50% 이상을 보면, Escherichia coli는 cephalothin, amikacin, carbenicillin, colistin, chloramphencol이었고, Pseudomonas Sp.는 The risk of nosocomial infection in Kyungpook National University Hospital patients was investigated by bacteriologic and retrospective studies from January to December, 1985. Of the 9,116 patients screened by bed-side examination, 439(4.8%) were found to be have active nosocomial inections. The incidence of nosocomial infections by clinical types was found to be highest in urinary tract (41.6%), followed by wound of 37.6% and pneumonia of 14.2%. The least frequently encountered was sepsis of 6.2%. Certain operations and urinary catheterizations, underlying diseases such as malignancy, diabetews mellitus, chronic renal failure and burn, and categories of sex and age were found to be risk factors for nosocomial infection. When nosocomial infection was classified by hospital services, the infection was more common in surgical services than in medical measures. Of the srugical services, it was most frequently encountered in the orthopedic surgery. A total of 549 strains of nosocomial pathogens were isolated. The most frequently encountered strain was Pseudomonas species 18.9%, followed by E. coli 13.3%, Acinetobacter calcoaceticus 13.3%, Staphylococcus aureus 9.1%, Enterobacter species 7.8%, Serratia marcescens 7.5%, and Enterococci 7.1%, respeceively. The antibiotic sensitivity patterns of isolates of nosocomial pathogens showed multi-drug resistance. Almost all of gram-negative bacilli were resistant to ampicillin, cephalothin and chloramphenicol. Of which, some isolates of Pseudomons species, E. coli and Acinetobacter calcoaceticus were resistant to both aminoglycosides and ce[phalosporins. The isolates of gram-positive cocci were resistant to penicillin G, moxalactam, amikacin, erythromycin, clindamycin and lincomycin. The isolation rate for methicillin resistant Staphylococcus aureus was 60%, amikacin resistant 54%, and β-lactam and aminoglycoside resistant 48%, respectively.