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.

EDI 도입 및 실행의 결정요인과 성과에 관한 문헌연구

문희철,정인영,성봉석 충남대학교 경상대학부설 경영경제연구소 1996 경영논집 Vol.12 No.1

포도알균 균혈증 환자에서 사망 예측 위험인자

문수연,이미숙,손준성,이희주,이상오 대한감염학회 2008 감염과 화학요법 Vol.40 No.3

Background : Staphylococcus aureus is a common cause of severe infection and frequently results in death or disability. We investigated potential risk factors influencing clinical outcome in S. aureus bacteremia (SAB). Materials and Methods : Our study is based on retrospective chart review for episodes of SAB from 168 patients, identified between January 2003 and December 2005. Twenty patients were excluded: 2 patients with infective endocarditis and 18 patients with metastatic lesions. Demographic, underlying diseases, sources of SAB, antimicrobial therapy, laboratory, and microbiologic characteristics were identified. Outcome was classified as death or survival 12 weeks after onset of SAB. Results : A total of 97 patients had survived and 51 patients died 12 weeks after the onset of SAB. Death group was older (66.4±13.6 vs. 59.4±14.9 years, P=0.007) and had higher Acute Physiology and Chronic Health Evaluation II system score (17.5±6.3 vs. 13.5±5.1, P<0.001) and the acute physiology score (11.1±5.5 vs. 8.0±4.3, P<0.001). Patients with nosocomial SAB (36 (70.6%) vs. 49 (50.5%), P=0.03] and ineradicable primary source of SAB (46 (90.2%) vs. 66 (68.0%), P=0.005] were more vulnerable to death. Multivariate analysis shows that hospital acquisition [adjusted odds ratio (OR)=2.93), ineradicable primary source (adjusted OR=5.74) and high APACHE II score (adjusted 0R=1.22) lead to higher mortality rate from SAB. Conclusion : Our study shows hospital acquisition, ineradicable primary source, and high APACHE II score are the risk factors related to death from SAB. On the other hand, methicillin resistance or initially ineffective antimicrobial therapy is not much correlated with mortality rate from SAB. 목적 : 황색포도알균은 중증 감염의 흔한 원인이며, 사망하거나 합병증이 발생하는 경우가 종종 있다. 본 연구를 통해 황색포도알균 균혈증 환자에서 임상적 결과에 영향을 미칠 수 있는 위험인자를 확인해 보고자 한다. 재료 및 방법 : 본 연구는 2003년 1월부터 2005년 12월까지 3년간 168 명의 환자에서 발생한 황색포도알균 균혈증에 대해 후향적 의무기록 조사를 바탕으로 이루어졌다. 성별, 나이, 기저 질환, 황색포도알균 균혈증의 원발 병소, 항생제 사용력과 미생물학적 특징에 대한 자료를 모았으며, 균혈증 발생 당시 질환의 중증도는 acute physiology score (APS)와 APACHE II 점수(acute physiology and conic health evaluation II system, APACHE II score)를 이용하여 측정하였다. 결과는 균혈증 발생 12 주 후 사망과 생존으로 나누어 분석하였다. 결과 : 황색포도알균 균혈증 발생 12 주 후 97명의 환자가 생존하였으며, 51명이 사망하였다. 사망 환자 군이 나이가 더 많았으며(66.4±13.6 vs. 59.5±14.9세, P=0.007), APACHE II 점수(17.5±6.3 vs. 13.5±5.1, P<0.001)와 APS (11.1±5.5 vs. 8.0±4.3, P<0.001)가 높았다. 병원 내 감염에 의한 황색포도알균 균혈증 환자[36 (70.62%) vs. 49 (50.5%), P=0.030]와 제거 불가능한 원발 병소를 지닌 경우[46 (90.2%) vs. 66 (68.0%), P=0.005] 사망위험성 이 높았다. 다 변량 분석에 의하면 병원 내 감염[adjusted odds ratio (OR)=2.93]과 제거 불가능한 원발 병소(adjusted OR=5.74), 높은 APACHE II 점수(adjusted 0R=1.22)에 의해 황색포도알균에 의한 사망률이 증가하였다 결론 : 본 연구에서 병원 내 감염과 제거 불가능한 원발 병소, 높은 APACHEH 점수가 황색포도알균 균혈증에 의한 사망과 관련된 위험인자이다. 반면, 메티실린 내성과 초기 부적절한 항생제 사용은 황색포도알균 균혈증의 사망률과 연관성이 없었다.

치면 산처리가 Ⅴ급 와동의 compomer 수복에서 미세누출에 미치는 영향

문상희,이창섭,이상호 대한소아치과학회 2000 大韓小兒齒科學會誌 Vol.27 No.2

치면 산처리가 Ⅴ급 와동의 compomer 수복에서 미세누출에 미치는 영향을 평가하기 위하여 180개의 발거된 건전한 치아에 생리적인 치수내압을 가한 시편을 제작하였으며, CEJ 1mm 상방에 6 ×3 ×2mm의 상자형 Ⅴ급 와동을 형성하여 수복재료 및 산처리 시간에 따라 다음과 같이 30개씩 6개의 군으로 분류하였다. A : Dyract AP + Prime & Bond 2.1 1군 : 산처리 없음, 2군 : 15초간 산처리 시행, 3군 : 30초간 산처리 시행. B : F2000 + Single Bond adhesive 1군 : 산처리 없음, 2군 : 15초간 산처리 시행, 3군 : 30초간 산처리 시행. 산처리를 제외한 모든 수복과정은 제조회사의 지시에 따랐으며, 수복 후 시편은 5~55℃에서 500회의 thermocycling을 거쳐 5% methylene blue 용액에 5시간 동안 침적 후 교정용 투명레진에 매몰되었다. 저속용 경조직 절단기로 시편을 절단 후 20배율의 stereoscope 하에서 미세누출을 관찰하여 다음과 같은 결론을 얻었다. 1.교합벽에서 Dyract AP는 산처리를 시행한 군이 산처리를 시행하지 않은 군에 비해 유의하게 낮은 미세누출을 보였지만(p〈0.05), F2000에서는 산처리 여부가 미세누출 정도에 유의차를 보이지 않았다(p〉0.05). 2.치은벽에서 Dyract AP는 산처리를 시행하지 않은 1군이 2군에 비해 유의하게 높은 미세누출 정도를 보였지만(p=0.003), 3군과는 유의차를 보이지 않았고(p=0.99), F2000에서는 산처리가 미세누출을 유의하게 감소시켰다(p〈0.05). 3.교합벽과 치은벽의 비교에서, 두 재료 모두 교합벽에서 낮은 미세누출 정도를 보였지만, Dyract AP의 3군에서는 유의성을 보이지 않았다(p=0.117). 4.두 재료 모두 2군과 3군 사이의 미세누출 정도에서는 유의차를 보이지 않았다(p〉0.05). 이를 종합해 볼 때, compomer 수복 시 산처리는 미세누출을 감소시키는 유효한 방법이라고 사료된다. 주요어 : compomer, 5급와동, 미세누출, 산처리, 생리적인 치수내압

한국 수출기업의 인터넷 활용실태

문희철,심상렬,송우용 한국통상정보학회 1999 통상정보연구 Vol.1 No.1

인터넷 및 전자상거래의 확산과 함께 국내에서도 인터넷을 이용한 수출에 대한 관심이 증대되고 있다. 본 연구에서는 인터넷 전자상거래에 관한 문헌연구와 다수의 수출기업들을 대상으로 이들의 인터넷 전자상거래의 도입 및 활용실태에 관한 실증분석을 통해 인터넷을 이용한 수출을 촉진하기 위한 방안에 대해 검토한다.

Primary Structure의 Homology로부터의 고찰

성문희 한국생화학분자생물학회 1991 생화학분자생물학회 소식 Vol.11 No.1

A database of 118 amino acid sequence of pyridoxal 5'-phosphate (PLPI-dependent enzyme was compiled. The aminotransferases with a total of 30 amino acid sequence of 7 different enzymes constitute the largest group among them. These 7 aminotransferases could be classified in to three families of the basis of sequence similarity. Aspartate aminotransferase family (family Ⅰ) comprises aspartate, aromatic amino acid, and tyrosine aminotransferases; o-amino acid aminotransferase family (family Ⅱ) o-amino acid: pyruvate aminotransferase and ornithine 6-aminotransferase; D-amino aminotransferase family (family Ⅲ) D-amino acid aminotransferase and L-branched-chain amino acid aminotransferase. Comparison of the amino acid sequence with those of family I from other organisms revealed very low overall similarities (13%). Several amino aciresidues conserved in all the compared sequence include those that have been reported to participate in binding of the coenzyme in three-dimensional structures of the vertebrate and E. coli enzymes. In family I and Ⅱ the sequence identity after alignment was 35% and 31%, respectively.

급성 출혈성 대장염으로 오인된 궤양성 대장염 1예

문희정,장병익,김승범,이호찬,박재현,은종렬,김태년 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract that affects the large bowel, Its etiology remains controversial. However, an infectious or immunologic origin is considered the primary cause. The onset of UC is typically slow and insidious, but some patients may present acutely with symptoms mimicking infectious colitis. We report a case of ulcerative colitis mimicking acute hemorrhagic colitis at initial presentation. A 60-year-old man was referred to Yeungnam University Hospital for bloody diarrhea and abdominal pain. Sigmoidoscopy revealed mildly edematous mucosa in the rectum and hyperemic mucosa with petechiae in the sigmoid colon. The patient was treated with antibiotics for several days, and his symptoms improved. However, after one month, his bloody diarrhea relapsed. Follow-up sigmoidoscopy revealed mucosal friability in the rectum and sigmoid colon. He was diagnosed with ulcerative colitis, and his symptoms were improved with mesalazine and a steroid enema.

산청 지역에 분포하는 중·염기성 암맥군의 암석학 및 고자기학적 연구 : 암맥군의 암석학적 연구

문은희,이상원 부산대학교 과학교육연구소 2003 교사교육연구 Vol.42 No.-

The dike swarms exposed in Sancheong area are classified into intermediate and mafic dikes, which the intermediate one is more dominant. The dike swarms exhibit aphanitic (or aphanitic porphyritic) texture to very fine-grained granular texture, the latter is typical in the mafic dikes. The dike swarms intruded into all kinds of rocks such as Precambrian gneisses, anorthositic rocks and Mesozoic syenite with average thickness of 1 meter (range from 0.3 m to 10 m). The dike swarms occurred as average of N45°E strike with nearly vertical dip, which its strike coincides with the direction of major faults such as Baekmudong, Kwangjeomdong fa버ts in Jiri Mountains and unidentified faults in northern region of Sancheong. So we considered the dike swarms intruded along fractures anψor fracture zones related to the northeast strike of faults. Geochemistry of the dike swarms and stocks of diorite and gabbro closely related to the dike swarms spatially and temporally was discussed. The dike swarms and the related rocks belong to sub-alkaline rock series and represent the differentiation trend of calc-alkaline rock series. In geochemistry the dike swarms and diorite are similar to compositional variation of major elements, and primitive mantle- and N-type MORBnormalized abundance patterns of trace elements and REEs. Petrochemical characteristics indicate the origin of those rocks is identical as considered to be derived from a same magma. Parental magma of the dike swarms and diorite is concluded to be generated from partial melting of crustal materials such as amphibolite fusion. So diorite and the dike swarms are formed from crystallization of the magma derived from partial melting of amphibolite in the crust. Otherwise, gabbro displays some differences in abundance patterns of trace and rare earth elements. The primarγ magma of gabbro is assumed to be derived from partial melting of mantle peridotites. And gabbro is very similar to the gabbroic rocks occurred at Macheon 따ea in the mineralogy, geochemistry and rock types. In tectonomagmatic discriminant diagrams it is considered that all of the studied rocks are formed from magmas occurred in tectonic environment as continental margin anφor island arc that mean the destructive plate margin as subduction zone.

서로 다른 이중에너지 방사선흡수기계 기종 (Hologic QDR 4500-A 와 Lunar EXPERT-XL)간의 골밀도 교차 보정

문대혁,김기수,이희경,김재승,신중우,조진만,김상욱 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.3

Purpose: A cross-calibration equation is needed to compare bone mineral density measured by different dual X-ray absoptiometry systems. We performed this study to establish appropriate cross-calibration equations between two different dual X-ray absorptiometry systems. Materials and Methods: Bone mineral density of anterior-posterior lumbar spine (L2-4 level) and femoral neck were measured in 109 women (55±11yr) using two different dual X-ray absorptiometry systems (Lunar EXPERT-XL) and Hologic QDR 4500-A). Bone mineral density values measured by two systems, including area, bone mass content, bone mineral density and percentile of young normals were compared and cross-calibration equations between two systems derived. Results: The bone mineral density values of 109 women measured by Lunar system were 0.958±0.17 g/cm2 at L2-4 and 0.768±0.131 g/cm2 at femur neck, which were significantly higher (13±6% at L2-4 and 19±7% at femur neck, p<0.001) than those (0.851±0.144 g/cm2 at L2-4 and 0.649±0.108 g/cm2 a neck) by Hologic system. Bone mineral content and percentile of young normals measured by Lunar system were also significantly higher than those by Hologic system (p<0.001), whereas there was no difference in area (p>0.05). There was a high correlation between bone mineral density values of L2-4 and femoral neck obtained with both dual X-ray absortiometry systems (r=0.96 and 0.95, respectively). Cross-calibration equations relating the bone mineral density were Lunar=1.1287×Hologic-0.0027 for L2-4 and Lunar=l.1556×Hologic+0.0l82 for femoral neck. Conclusion: We obtained cross-calibration equations of bone mineral density between Lunar EXPERT-XL and Hologic QDR 4500-A. These equations can be useful in comparing bone mineral density obtained by different dual X-ray absorptiometry systems.

흰쥐 재생간의 알콜대사효소들의 활성치

문교철,곽춘식,정성광,김여희 啓明大學校 醫科大學 1988 계명의대학술지 Vol.7 No.2

A study was made on the change in the activities of the following during 10 post-operative days: alcohol dehydrogenase of regenerating rat livers after 70% (median and left lateral lobes) partial hepatectomy. After partial hepatectomy in the rats, activities of regenerating liver alcohol dehydrogenase significantly increased in the sixth day. The activities of microsomal ethanol-oxidizing system in the regenerating liver markedly increased from the third day after partial hepatectomy. However, no significant changes in hepatic catalase was noted throughout the experiments. The activities of cytosolic and microsomal aldehyde dehydrognease in the regenerating liver significantly increased from the sixthe day and the third to the sixth day respectively, but mitochondrial aldehyde dehydrogenase showed no change.