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.

트레드밀 운동시 흡기근 테이핑이 폐활량에 미치는 영향

김민지,신수영,송월섭,조수진,최동락,황미진,황진규,박진현,김경,Dennis W. Fell 대구대학교 특수교육재활과학연구소 2011 再活科學硏究 Vol.29 No.1

이 연구는 트레드밀 운동과 키네시오 테이핑의 효과에 따른 폐활량의 변화를 알아보기 위해 26명의 비흡연자가 참가하였으며 키네시오 테이핑을 적용하지 않은 그룹과 키네시오 테이핑을 적용한 두 그룹으로 무작위로 배정하고 각 군들을 주 3회 6주간의 트레드밀 훈련을 실시하였다. 실험 전과 후, 스파이로미터를 사용하여 키네시오 테이핑의 적용 따른 폐활량 변화 효과를 측정하였다. 이 연구의 결과를 종합해보면 키네시오 테이핑을 적용 그룹에서 적용하지 않은 그룹에 비해 FVC, FEV1에서 유의한 증가를 보였다. 이러한 결과는 건강한 성인에서 키네시오 테이핑을 적용한 경우 키네시오 테이핑을 적용하지 않고 트레드밀 운동을 한 경우보다 폐활량의 향상에 효과적이라고 생각되어진다. The purpose of this study was to investigate the variation of vital capacity(VC) according to the effects of kinesio taping with treadmill exercise. Twenty-six non-smokers were participated in this research and these subjects were randomly assigned into two groups. To measure the VC variation effects of kinesio taping, spirometer was used. The collected data were analyzed statistically by using a paired Mauchly test and repeated measure ANOVA. The results of this study were as follows; A group: treadmill with kinesio taping B group: treadmill without kinesio taping. Between A and B, there were significant differences. In the case of A group, there was 11.66% increase of VC, during 3 weeks experiment(p<.01). In the case of B group, there were significant differences, 3.35% increase of VC, during 3 weeks taping intervention(p<.01). After 6 weeks experiment, the improvement of VC shown a significant difference with intergroup (p<.05). From this result, it was revealed that treadmill exercise with kinesio taping was effective to improve VC to healthy adult than treadmill exercise without kinesio taping.

다방성 낭성 신종 1예

최수정,김진국,황승덕 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Multilocular cystic nephroma is a rare and non-inherited benign renal neoplasm occuring in the both children and adults. It is necessary to make a differential diagnosis from all renal diseases with a cystic component, such as simple cyst, metastatic renal tumor, cystic adenoma or angiomyolipoma in adults. We report a case of multilocular cystic nephroma presented with painful abdominal mass treated with laparoscopic nephrectomy and confirmed with pathology.

미계측 유역의 부유물질 산정을 위한 다중회귀식 개발

최한규,박재용,박수진 강원대학교 산업기술연구소 2006 産業技術硏究 Vol.26 No.B

The purpose of this study is to present quantitatively the influence of variables that had the largest effect on the changes in suspended solids(SS), which would cause turbid water phenomenon, among water quality factors of the non-point pollution source, and then to develop a multiple regression equation of SS and predict the water quality of ungaged watersheds so as to provide basic data to establish efficient management plans for SS which flow in rivers and lakes. To identify the correlation of SS with the amount of rainfall and the state of land use, a simple correlation analysis and a simple regression analysis were conducted respectively, Finally, a multiple regression analysis was conducted to provide that SS were set as dependent variables while the amount of rainfall, paddy fields and dry fields were set as independent variables. As a result, the amount of rainfall had the most significant influence on changes in SS, followed by dry fields and paddy fields. In addition, the multiple regression equation was developed to predict SS in unmeasurable watersheds.

국내 조혈모세포이식 환자에서 Human Cytomegalovirus gB 유전형의 분포와 질환과의 연관성 : 예비 보고

최수미,김진희,이동건,박선희,최정현,유진홍,박철민,이종욱,민우성,황응수,신완식,김춘추 대한감염학회 2007 감염과 화학요법 Vol.39 No.2

목적 : 사람 거대세포바이러스(Human cytomegalovirus, 이하 HCMV) glycoprotein B (gB)는 UL55 유전자에 의해 부호화되는 당단백으로, UL55 유전자의 염기서열변화에 따라 4가지 유전형으로 나뉜다. 본 연구에서는 국내 조혈모세포이식 환자들에서 HCMV gB 유전형의 분포와 그 특성을 알아보고, gB 유전형에 따라 특정 HCMV 질환 발생과 연관이 있는지 그 임상적 의미를 분석해 보고자 하였다. 재료 및 방법 : 동종 조혈모세포이식 환자 52명의 혈액검체 94개에 대해, Chou 등이 제시한 방법에 따라, 먼저 UL55 유전자 부위를 nested PCR로 증폭한 후, RsaI과HinfI으로 Restriction fragment length polymorphism(RFLP) 분석을 시행하였다. 결과 : gB type 1은 73.1% (38/52), gB type 2는 13.5%(7/52), gB type 3는 1.9% (1/52), gB type 1과 type 2에 의한 혼합감염은 9.6% (5/52)로 나타났다. gB type 4는 관찰되지 않았다. 1명(1.9%)에서 gB 유전형을 결정할 수 없었는데, RFLP 패턴으로 보아 Trincado 등이 제시한 gB type 7에 해당하는 것으로 생각되었고, 이 새로운 아형에 대해서는 현재 염기서열 분석 중이다. 52명 중 5명(9.6%)에서 HCMV 질환이 발생하였고, 3명에서 HCMV 폐렴, 1명에서 망막염과 위장관염, 나머지 1명에서 망막염이 발생하였다. 5명 중 HCMV 질환과 관련하여 사망한 예는 없었고, 감염된 HCMV는 모두 gB type 1이었다. HCMV gB유전형과 HCMV 질환 발생 사이에 유의한 연관성은 없었고, 단일 주에 의한 감염과 혼합감염에 따른 HCMV 질환발생 사이에도 유의한 연관성은 관찰되지 않았다. 자료 분석 중 gB type 2에 감염되어 있던 환자에서 gB type 1에 재감염 되면서 발열, 간효소 수치 상승 및 pp65 HCMV 항원혈증이 나타난 예가 있었다. 결론 : 연구결과 gB type 1이 아주 우세하고, gB type 4는 검출되지 않았으며, 혼합감염의 빈도가 비교적 낮은 분포를 보였다. 이는 외국의 보고와는 다른 국내 조혈모세포이식 환자에서의 독톡한 감염 양상으로 추정된다. 본 연구에서 HCMV gB 유전형과 질환 발생과의 연관성을 밝힐 수는 없었으나, HCMV 유전형에 대한 연구는 바이러스 감염의 발병기전이나 전파 경로 및 양식과 같은 역학적 연구에 중요한 자료가 될 것이다. 현재 더 많은 수의 조혈모세포이식 환자를 대상으로 연구가 진행 중에 있으며, 앞으로 다른 질환군의 환자나 건강한 잠복 감염자에서의 추가 연구가 필요할 것으로 생각된다. Background : Human cytomegalovirus (HCMV) glycoprotein B (gB) is the major envelope glycoprotein, encoded by the UL55 gene. Based on sequence variation in the UL55 gene, HCMV can be classified into four gB genotypes. Previous studies have suggested an association between HCMV gB genotypes and clinical outcome in the immunocompromised hosts. The goal of this study was to determine the distribution of HCMV gB genotypes and the effect of gB genotype in the developement of HCMV diseases in hematopoietic stem cell transplant (HSCT) recipients in Korea. Materials and Methods : DNA was extracted from 94 blood specimen of 52 allogeneic HSCT recipients with HCMV infection. HCMV gB genotype was determined using polymerase chain reaction to amplify a region of UL55, followed by restriction fragment length polymorphism (RFLP) analysis based on RsaI and HinfI digestion. Results : The distribution of gB types were as follows: gB1, 73.1% (38/52) of patients; gB2, 13.5% (7/52); gB3, 1.9% (1/52) and mixed infection (gB1 and gB2), 9.6% (5/52). While gB4 was not detected, a new genotype (described as gB7 by Trincado et al, 2000) was identified on the basis of their RFLP pattern. During average 708 days’ follow up period, HCMV diseases developed in 5 patients. All of them had gB1 genotype. There was no statistically significant association between the incidence of HCMV diseases and the gB genotypes. Re-infection with gB1 strain was detected in one patient who had been previously infected with gB2. This episode was associated with fever, elevated liver enzyme and positive antigenemia. Conclusion : HCMV gB1 was the dominant genotype and no gB4 was detected in allogeneic HSCT recipients in Korea, which is an unique pattern compared with the previous reports. Although we can not find significant association between the HCMV diseases and the gB genotypes, genotyping of HCMV will serve in the study of pathogenesis and transmission of this virus in transplant patients. Further study is underway with large study population.

수혈을 거부하는 혈액투석환자에서 상부위장관 출혈의 무수혈적 치료 1예

최수정,김진국,황승덕 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

The incidence of bleeding complications may be decreasing. But, upper gastrointestinal(UGI) bleeding is a still significant complication of chronic renal failure(CRF). Although there are many controversies about clear cut guidelines for blood transfusion, blood transfusions are critically important and essential in many emergency cases. Recombinant erythropoietin has been used in the past in treatment of anemia in Jehovah's witness patients from surgery, chemotherapy, and trauma. We here report a case of the use of erythropoietin in Jehovah's witness patients with an active upper gastrointestinal bleeding and chronic anemia from end-stage renal disease. A 59-year-old male Jehovah's witness patient with a past medical history of diabetes mellitus and end-stage renal disease(receiving hemodialysis) was admitted because of hematemesis and melena. He was diagnosised with gastric ulcer on emergency gastroenteroscopy and treated with argon plasma coagulation. His hematocrit was 12.1% at admission. He refused blood transfusion and was treated with intravenous iron, ulcer medication and high dose erythropoietin. After 2 weeks, he was discharged with hematocrit 23%.

피부화상으로 유도된 급성 부종성 폐손상에 대한 사순청량음의 효능

최진용,강병수,조현국 대한본초학회 2002 大韓本草學會誌 Vol.17 No.2

Objectives : The present study was conducted to determine whether administration of heat extracts of Sasunchungtyangeum has an inhibitory effect of neutrophil-derived oxidative injury following dermal scald burn in rats. Methods: Acute lung injury was induced by scald burn (15% of TBSA) in rats. To identify acute lung edematous lung injury, 5 hrs after skin burn, protein concentrations and numbers of polymorphonuclear leukocytes in bronchoalveolar lavage (BAL) were measured. In addition, levels of lung KC (neutrophil chemoattractant cytokine) and activities of lung myeloperoxidas (MPO) were measured, and morphological changes were observed. Results : Lung weight and concentration of BAL protein, the index of lung injury were clearly increased at 5 hrs postburn compared to them of sham. Administration of heat extracts of Sasunchunryangeum after scald burn inhibited the production of KC in lung tissue and decreased the activity of lung MPO related to influx of neutrophils. In histological changes, edematous lung injury with infiltration of inflammatory cells induced by skin burn were decreased by administration of heat extracts of Sasunchunryangeum after scald burn. Conclusions : These results suggest that Sasunchunryangeum may be a successful medical stuff in acute lung injury by skin burn.

소양호 상류유역의 부유물질 유출특성에 의한 원단위 산정에 관한 연구

최한규,최순규,박수진 강원대학교 산업기술연구소 2006 産業技術硏究 Vol.26 No.B

In this research, we have selected the regions of Naerin river and Inbuk river where agricultural activities are actively carried out in the upper Soyang Reservoir and we have observed the changes of water quality while raining after finding out the characteristics of the outflow of floating materials by measuring the water quantity and water quality in division of rainy season and non-rainy season for those floating materials of generating pollutions of turbidity and malnutrition of the water for 4 years from 2002 to 2005. Results of the observation showed that the outflow of floating materials is significantly affected by the surface outflow of rain water, in particular, the surface outflow was great in June-August period of flood seasons.

응급실내에서 발생한 폭력의 실태

최웅지,조남수,조수형,김성중,박광철,박진실 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Background and Objectives: The objective of this study was to obtain circumstances about violence providers and cause of the violence in emergency room. Materials and Methods: Reports were provided to emergency department doctors, nurses and emergency medical technicians working in Chosun University Hospital Emergency Center during the sixty days from 26 May 2003 to 24 July 2003. Report form consisted of the degree of violence, the reason for the violence, dermographic information about violence providers, outbreak time of violence and response of emergency personnels. Results: SixtyUeight case of violence in the emergency department were reported. Almost all of the violence was due to the male gender and high incidence in third and fourth decade. The violence occured mostly in the night shift. 55.9% of violence was done by patient and 41.2% was done by patient's guardians. The leading cause of violence were alcohol drunken and delay of laboratory test and treatment. Verbal abuse and threats were the most concern form of violence, Conclusion: It is necessary to solve the problems faced in the emergency department not only administrative and financial aid but also regular preventive education and further study.

하청 근로자들의 건강수준 평가

최홍열,고상백,장세진,차봉석,임형준,이상윤,김재용,강동묵,조수헌 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.1

목 적 : 하청노동을 이용한 노동 유연화 전략은 근로자들의 고용을 불안정시키고, 근로자들의 삶에 부정적 영향을 미치고 있다. 따라서 이 연구는 하청업체 근로자들의 고용현황을 조사하고, 기존의 업체중심의 건강평가의 문제점을 지적하고자 하였다. 또한 하청업체 근로자들의 건강평가의 현재적 의미와 사회적 배제의 특성을 알아보고자 하였다. 방 법 : 모기업과 하청업체 근로자들의 건강수준을 비교하기 위하여, 정기건강진단(일반, 특수)과 채용건강진단 자료를 이용하고자 하였다. 건강진단에서 누락된 비정규직을 포괄하기 위하여 SF-36을 이용하여 건강설문조사를 시행하였다.결 과 : 조선업 하청업체 근로자들의 고용기간은 짧고, 빈번한 노동이동 현상을 보였다. 3년간 건강진단 수검 현황을 통해 살펴볼 때, 1998년 수검자중 2000년까지 연속해서 검진 받은 수검자는 40.3%였다. 건강진단 결과 유소견자 규모를 통해 모기업과 하청업체간의 건강수준을 비교해 보았다. 모기업은 일반질병 요관찰자와 질병자를 포함한 유소견자가 1,011명으로 약 10 %의 유소견율을 보이고 있고, 질병자의 경우 596명으로 유병률이 5 %를 상회하고 있다. 반면 하청업체의 경우 1,967명의 수검자중 유소견자가 115명으로 6 %의 유소견율을 보이고있고, 질병자는 82명으로 4 %의 유병률을 보이고있다 채용건강진단을 받은 수검자는 6,260명 이었으며, 이 중 유소견자 수는 2,373명으로 전체 수검자의 37.9 %를 차지하였다. 건강설문지의 경우는 전체 건강수준의 총합은 하청보다 원청 근로자가 높았고 통계적으로 유의하였다. 결 론' 정기건강검진 결과는 하청근로자들이 고용형태에 따라 검진을 받지 못한 경우가 많아, 건강 근로자 효과로 표현될 가능성이 있다. 따라서 채용건강진단 결과는 다른 측면에서 하청업체 근로자들의 건강수준의 현실적 반영이라고 할 수 있다. 향후 하청업체 근로자들의 건강문제를 감시하고 개선하려면 기존의 업체 중심의 접근으로는 하청 근로자의 건강문제를 제대로 다룰 수 없고, 업종과 지역을 동시에 고려하여 접근할 필요가 있다. 또한 단기 고용 근로자 및 비정규직 근로자를 사회보장의 확충과 모기업의 연대책임 강화 및 기업복지 차원에서 포괄하는 방안이 모색되어야 하겠다. Objectives : The strategy for the labor flexibility through subcontracted labor have brought a negative effect on the lives of the workers, such as the increase of the unstable employment. This study was conducted to analyze the relationship between the employment of subcontracted firms and the health status of them, and to find out some problems which have been caused in the process of health evaluation and the characteristics of social exclusion. Methods : We reviewed the periodical health examination and preemployment health examination in order to compare health status of the subcontracted workers with those of the parent firm workers. The SF-36 questionnaire was administered to assess the self-perceived health status. Results : The result shows that compared to the working duration of the parent firm workers, those of the subcontracted workers were shorter, and the job transfer rate was higher. In the periodical health examination, the prevalence of occupational and general disease was higher in the parent firm(10%) than in the subcontracted firms(6%). Preemployment health examination plays an important role in worker's health manage- ment. Among 6,260 workers who received preemployment health examination, the prevalence of disease was 37.9%. Mean scores of health status measured by SF-36 were lower in the subcontracted firm than in the parent firm. Conclusions : Due to social exclusion of the subcontracted workers from the periodical health examination, there is a possibility that the periodical health examination have the healthy worker effect. These results suggests that the preemployment health examination could be a more appropriate indicator which is able to assess the health status of the subcontracted workers than the periodical health examination.