종합검진센터 내원자에서 관상동맥질환 위험요인들의 분포

이충원,이종영,박종원,윤능기,김영조,이현우,이무식,서석권 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.3

1991년3월부터 8월사이에 대구시에 소재한 1개의 대학병원의 종합검진센타에 내원해서 종합검진을 받은 남자 422명(69.9%)과 여자 182명(30.1%)을 대상으로 하여 심헐관계질환의 위험요인들의 전체적인 분포를 보았다. 평균 연령은 남자가 43.3(표준편차, 10.3), 여자가 44.4(표준편차, 10.8)였다. 남자에서 연령에 따라 0.05 수준에서 통계적인 유의성을 보인 위험인자는 혈청 총콜레스테롤(TC). 트리글리세라이드(TC), 고밀도 지단백콜레스테롤(HDL), 저밀도 지단백콜레스테롤(LDL), 수축기혈압, 비체중, A형행동양상이었으며 생활습관으로서는 음주, 흡연, 규칙적인 운동, 우유와 커피섭취, 수면 등이었다. 여자에서는 TC, TG, LDL, 수축기와 확장기혈압, 비체중 그리고 커피섭취와 수면 등이었다. 남자에서 총콜레스테롤의 평균은 181.7mg/dl(표준편차, 32.2), 여자는 182.5mg/이(표준편차, 42.2)였다. 대부분의 위험인자들은 구미의 수준에 미치지 못했으나 남자에서 흡연율이 전체적으로 61.8%로 높으 수준이었으며 특히, 20~29세가 72.9%, 30~39세가 75.2%로서 다른 연령군에 비해 상대적으로 높았다. 여자에서는 전체적으로 6.0%에 지나지 않았다. 확장기혈압 90mmHg 이상을 고혈압자로 정의했을 때의 유병률이 여자 전체대상자에서 24.7%로 높았으며 50-59세는 표본수가 적어서 문제가 되었으나 53.1%였다. 어떤 인구집단내에서 총콜레스테롤의 평균이 200mg/dl 미만이면 고혈압과 흡연의 인구집단의 수준에 관계없이 관상동맥질환(coronary heart disease)의 발생은 드문 것으로 보고가 되고 있으므로 당분간 관상동맥질환 발생률의 급속한 절대적인 증가는 힘드리라 사료된다. 그러나 이러한 결과는 본 연구의 대상자들이 대표성을 지니지 못하며 건강검진센터에 자발적으로 내원한 사람들이므로 해석에 주의를 요한다. Authors examined the distributions of the risk factors for the coronary heart disease in the 422 male (69.9%) and 182 female (30.1%) visitors to the health examination center of a university hospital located in Taegu March to August 1991. Mean age of males was 43.3(standard deviation, SD 10.3) and that of females was 44.4(SD 10.8). Total cholesterol(TC), triglyceride (TG), high-density lipoprotein and low-density lipoprotein cholesterol(LDL), systolic blood pressure, Quetelet index, and Type A Behavior Pattern, and some of life habit variables(alcohol intake, smoking, regular exercise, milk and coffee intake and sleeping) were statistically significant in age groups of the males(P<0.05). In the females, TC, TG and LDL, systolic and diastolic pressure, Quetelet index, coffee intake and sleeping were statistically significant in age groups (P<0.05). Mean of total cholesterol was 181.7㎎/dl(SD,32.2) in males and that of females was 182.5㎎/dl(SD,42.2). Most of the risk factors levels were lower than the Euro-Americans', while smokers were high with 61.8%, especially 72.9% in 20-29 age group and 75.2% in 30-39 age group in males. In females, smokers were just 6.0%. Hypertensives defined by more than 90mmHg diastolic pressure were 24.7% in females, particularly 53.1% in 50-59 age group, but size of the strata was rather small(N=49). In the light of the report that coronary heart disease is uncommon irrespective of population levels of smoking and hypertension, where average total blood cholesterol level in a population is low(<200mg/dl), it is not likely that the absolute increase of the number of the coronary heart disease will increase markedly in the near future. But cautions should be exercised in interpreting the results of this study due to the lack of representativeness and volunteerism. .

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

당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

동종골수이식 후 혈당 및 혈중 지질농도의 변화양상 및 관련인자

이원영,강무일,오은숙,오기원,손현식,윤건호,차봉연,이광우,손호영,강성구,신완식,민우성,김춘주 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.6

연구배경:골수이식은 비교적 젊은 연령의 환자들을 대상으로 하며 면역억제제의 사용기간이 비교적 짧으므로, 주로 고령의 만성 질환 환자에서 시행되는 고형장기이식에서와는 달리 당대사 및 지단백 대사에 있어서 많은 차이점이 있을 것으로 추측된다. 저자들은 전향적 연구를 통하여 골수이식 후 시기별로 혈당 및 혈중지단백 변화 양상을 알아보고 이와 관련된 임상인자들을 규명하고자 하였다. 방법:1998년 10월부터 1999년 8월까지 가톨릭대학교 성모병원에서 동종골수이식을 시행한 환자들 중 43명을 대상으로 이식 전 및 이식 후 1, 2, 3, 4주와 3개월, 6개월에 공복 혈당, 혈중 총 콜레스테롤, 중성지방, 고밀도지단백을 측정하여 골수이식 후 시기별 변화를 관찰하고 여러 임상인자들에 따른 차이를 알아보았다. 결과:1. 공복혈당은 골수이식 수 첫4주 동안 상승하였고 이후 감소하였으나 이식 6개월 시점의 평균 공복혈당은 이식 전보다 유의하게 높게 관찰되었다. 혈중 총 콜레스테롤은 이식 후 1주에 최고치를 형성하였고 이후 기저수준으로 회복되었다가 이식 수 3,6개월에 다시 증가하여 기저치에 비해 유의하게 높았다. 혈중 중성지방은 이식 후 1개월까지 유의하게 증가하였고 이후 감소하여, 3,6개월에는 기저치와 유의한 차이가 관찰되지 않았다. 혈중 고밀도지단백은 이식 후 2,3주에 이식 전보다 유의하게 감소하였고 이후 이식 전 수준으로 회복되었다. 혈중 저밀도지단백은 총 콜레스테롤의 변화와 매우 유사하였다. 2. 골수이식 후 6개월 시점에서 공복 혈당이 126㎎/dL이상인 환자는 7명(16%)이었다. 이들 환자들과 공복혈당 126㎎/dL 미만의 환자 36명을 비교한 결과, 공복혈당이 126㎎/dL 이상인 환자군에서 스테로이드 평균 투여량이 많았고 고밀도지단백이 유의하게 낮았다. 3. 이식편대숙주질환이 발생한 환자는 그렇지 않은 환자보다 이식 후 1, 2, 3주 및 6개월의 총 콜레스테롤이 더 낮았고, 3개월의 공복혈당이 더 높았다. 혈연골수이식 환자군은 비혈연골수이식 환자에 비해 투여된 스테로이드 용량이 더 적음에도 불구하고 이식 후 1, 2, 3주 및 6개월의 총 콜레스테롤 수치가 더 높았다. 스테로이드 고용량 투여군(하루 평균 7.5㎎기준)은 저용량군보다 이식 후 3개월 시점의 공복혈당이 더 높았으나 나머지 시점의 혈당, 혈중 지질농도에 있어서는 유의한 차이가 관찰되지 않았다. 결론:골수이식 후 초기시기에 주로 당 대사 및 지질대사이상이 관찰되며 이는 면역억제제 투여와 관련이 있음을 알 수 있었다. 면역억제제가 고용량 투여되는 합병증 발생 시 이들 대사이상에 관심을 기울여 대처해야 할 것이다. Background: In bone marrow transplantation(BMT), recipients are usually younger and immunosuppressants are open used in shorter period than in solid organ transplantation. Therefore, there might be a difference in glucose and lipid metabolism between BMT and solid organ transplantation. However, the serial changes of metabolic parameters following BMT have not been studied. Therefore, the aim of this study is to investigate the serial changes of blood glucose, lipids and the putative factors that are related with these changes after BMT. Methods: We have prospectively investigated 43 patients who underwent allogeneic BMT. Fasting plasma glucose(FPG), total cholesterol, triglyceride and high-density lipoprotein(HDL) were measured before BMT, and at 1, 2, 3, 4, 12 weeks and 6 months after BMT. The serial changes of these metabolic parameters according to clinical factors including type of BMT, mean daily steroid dosage, and occurrence of graft versus host disease (GVHD) were examined. Results: 1. Mean FPG level increased during 4 weeks after BMT and remained above basal value at post-transplant 6 months. Total Cholesterol level was increased during initial 4 weeks after BMT and was above basal value at post-BMT of 3 and 6 months. Triglyceride level was progressively increased during initial 4 weeks after BMT, but returned to basal value there after. HDL-cholesterol level was significantly decreased during initial 4 weeks after BMT, but returned to basal value there after. 2. Patients with FPG above 126 mg/dL and the other patients, the former received larger amounts of daily steroid and had lower HDL-cholesterol level. 3. The changes of metabolic parameters were different according to type of BMT, steroid dose, and occurrence of GVHD. Conclusion: Although there was increase of FPG, TC, TG and decrease of HDL-C during initial 4 weeks after BMT, these metabolic changes recovered slowly thereafter. Immunosuppressants are thought to be associated with these changes. Further observation will be needed for the long-term effect of BMT on metabolic changes(J Kor Diabetes Asso 24:689~698, 2000).

일부 고등학생에서 성(性)적 활동의 위험요인 분석

이무식,김은영,천병철,이석구,전경희,최은주 한국모자보건학회 2000 한국모자보건학회지 Vol.4 No.2

K 대학병원 서어비스에 대한 소비자 만족도

이태섭,박종원,이무식,윤능기,이충원,서석권 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.3

Authors administered a questionnaire to 300 clients visited to the K University Hospital during August in 1992 to investigate the degree and related factors of consumer's satisfaction with the hospital services. Clients consisted of 82 in-patients and 158 out-patients, 52.4 percent of them was male. Four dimensions of satisfaction were assessed which were medical management, administration, environment and attitude. In-patients reported as dissatisfied with the waiting time during receipt, investigative medical procedures and pharmacy (64.7%), lack of conveniency facilities for patients and their guardians(48.8%) and provision of conveniency facilities in the ward(42.4%), unsanitary state of out- and in-hospital(41.5%). Out-patients reported dissatisfaction with the course of medical management and the time needed(70.3%), the waiting time during receipt, investigative medical procedures and pharmacy(68.3%), lack of conveniency facilities for patients and guardians(42.4%). But both in-patients and out-patients were satisfied with medical equipments, doctor's diagnosis reliability and medical effects, technician's attitude more than 50%. Canonical correlation analysis was done to find related sociodemographic factors to the four dimensions of satisfaction. Of the four canonical functions, the first was only statistically significant in in-patients. Its eigen value was 0.56 and its canonical correlation coefficient was 0.60. Satisfaction with environment and medical management was selected as important concept in dependent variables. Standardized canonical function of environment and medical management were 0.76 and 0.35 respectively. It was related with woman with high educational attainment and increasing number of hospital visits. In out-patients, the first, second and third function were statistically significant and their eigen values were 0.18, 0.4, 0.08 respectively which were small compared to those of in-patients. Their canonical correlation coefficient were 0.40, 0.35, 0.28 respectively. Low degree of environment but high degree of medical management satisfaction was noted in the first function which was related with old age, woman and professional occupation. Low degree of satisfaction with administration(second function) was related with city resident, non-professional occupation and young age. High degree of medical management but low degree of administration satisfaction(third function) was related with surgical visitor, man and non-professional occupation. The direction of hospital managerial strategies could be planned and general characteristics of dissatisfactory clients might be suggested with these results.

총 경정맥 영양 요법(TPN)중에 발생한 Wernicke-Korsakoff syndrome 1 예

이문수,김태윤,김성용,백무준,김창호,조무식 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Total parenteral nutrition is commonly known as a safe and convenient method of nutritional supplemantation for malnourished patients. Several metabolic complications have been adquately studied and reported their diagnosis and management. There was, however, no precisional data and studies of vitamin B1 deficiecy induced Wernicke's encephalopathy. And Wernicke's encephalopathy may be difficult to recognize, expecially if it is in the early stage and if all manifestation s are not yet present, and because a patients with Wernicke's encephalopathy may become comatose and die if the disorder is not diagnosed and vitamin B1 not given promptly. Therefore Wernicke's encephalopathy is emergent. We report a case of Wernicke-Korsakoff encephalopathy that was caused by vitamin B1 deficiency

建築工業敎育科 敎育改善에 관한 硏究 : 敎育課程을 中心으로 Focused on the development of curriculum

李昌甲,朴萬植,延吉煥,崔武革,李基男 충남대학교 공업교육연구소 1981 論文集 Vol.4 No.1

Due to the radical change of society and the technological innovation, it is inevitable to rearrange the educational objective of the Department of Architectural Engineering Education and to reorganize the curriculum responding to the objective. In this study, all the current curricula of architectural institutions have been analized to identify problems, and the educational objective of the department of architectural engineering education have been established based on the objective of the College of Industrial Education. As the result of the above studies, the model curriculum for the major subjects have been developed in order to have following characteristics. 1. The required subjects were limited to the basic fields in order to cover the education in the technical high school. 2. The elective subjects were organized into three fields, namely, architecture, structural engineering, and building materials and construction to meet the diversified demands to a possible maximum extent.

위암으로 오인된 악성 흑색종 수술 1 예 : A case report

이문수,김태윤,김성용,백무준,김창호,조무식 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

The malignant melanoma matastatic to the stomach is a rare tumor. Its treatment is controversial and median survival after diagnosis is usually <1year. Here a case of malignant melanoma metastatic to the stomach is reported in a 77 years old woman who presented with epigastric discomfort for three months, and was diagnosed as ademocarcinoma at preoperation. The patient was performed subtotal gastrectomy, gastroduodenostomy, omentectomy, and was discharged with no complication on the twenty-one posoperation day. We report a case of malignant melanoma metastatic to the stomach with a review of the literature.

Postweaning Multisystemic Wasting Syndrome (PMWS)에 이환된 자돈에 대해 Porcine circovirus 2 Rep 유전자 검출에 관한 연구

이용훈,김지영,楚佳奇,서상희,장경수,김명철,박창식,전무형 충남대학교 형질전환복제돼지연구센터 2007 논문집 Vol. No.10

Postweaning multisystemic wasting syndrome (PMWS) is a new emerging disease in swine herds world wide, and porcine circovirus type 2 (PCV2) is known as a major cause of PMWS. In this study, the prevalence of PCV2 Rep gene was examined for the serum, nasal swabs and feces collected from 30 heads of piglets affected with PMWS and 10 heads of normal healthy piglets using polymerase chain reaction (PCR). The diagnostic efficiency of the PCR was evaluated for different types of samples. Rep gene of the isolate (PCV2 S1) was then sequenced. In the group of PMWS-affected piglets, the prevalence of PCR-positive were 70.0% in sera, 33.3% in nasal swabs and 0% in feces. In the normal healthy group, the PCR-positive rates of sera, nasal swabs and feces were 30%, 20% and 0%, respectively. Seven piglets (17.5%) out of 40 showed the simultaneously positive results in both of sera and nasal swabs. The nucleotide sequence homology of Rep gene of PCV2 S1 as compared with the reference strain of PCV2 (GenBank accesson no.AF027217) was 99.3%.