• 대한치과의료관리학회지
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• 제5권1호
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• pp.45-54
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• 2017

이 연구의 목적은 치과 진료실에서 항생제 남용에 대처하기 위해 항생제 투여의 필요성을 결정하는 과정을 소개하고 적절한 항생제의 선택과 사용에 대한 정보를 공유하고, 지속적인 모니터링을 통해 항생제 처방의 적절성을 증가시키는 것이다. 본 병원의 가이드라인은 최신의 항생제 처방에 대한 연구 결과에 따랐으며, 향후에도 지속적인 항생제 처방 가이드 라인에 대한 보완이 필요할 것이다. 본 가이드라인에 의하면, 병력 검사에 의한 페니실린 알레르기 조사와 피부에서의 페니실린 알레르기 검사를 통해 아목시실린을 일차 선택적 항생제로 처방하였다. 증상의 경과에 대한 재평가 과정을 거친 후 아목시실린에 의한 약물 효과가 없다면 보다 광범위한 항생제로 대체하였고, 증상이 호전되지 않으면 환자를 상급병원으로 전원하도록 설계하였다. 사과나무치과병원 직원은 정기적으로 항생제 처방에 대해 모니터링을 하였고 이 결과에 대해 주기적으로 교육을 받도록 하였다. 현재의 가이드라인은 지속적으로 보완되어야 하며, 항생제 남용의 제어에 긍정적인 결과를 가질 것으로 생각되며, 전반적 치과 진료의 흐름에도 기여할 것으로 보인다.

• Tuberculosis and Respiratory Diseases
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• 제86권3호
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• pp.158-165
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• 2023

Asthma is a chronic inflammatory airway disease that is characterized by variable airflow obstruction. The Korean Asthma Study Group of the Korean Academy of Tuberculosis and Respiratory Diseases has recently updated the Korean Asthma Guideline. This review summarizes the updated Korean Asthma Guideline. Asthma prevalence is increasing worldwide, and in Korea. Variable airflow obstruction can be confirmed by bronchodilator response or other tests, and should be established prior to the controller medication. A low-dose inhaled corticosteroid-formoterol is used to alleviate symptoms in all treatment step, and it can be used as a controller as well as reliever in steps 3-5. This approach is preferred, because it reduces the risk of severe exacerbations, compared to the use of short-acting β2-agonist as reliever. In severe asthma, phenotype/endotype based on the underlying inflammation should be evaluated. For type 2 severe asthma, the biologics should be considered.

• 대한한방소아과학회지
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• 제12권1호
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• pp.111-131
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• 1998

1. In oriental medicine, the case of sinusitis can be explained, not only external invasion such as PUNG HAN(wind-cold), PUNG YUL(wind-hot), SHUP YUL(damp-heat), but also functional disorder of internal organ such as spleen(脾), lung(肺), kidney(腎) The western medicine classified the cause of sinusitis as two factors. That is bacterial infection factor-Haemophilus influenza, streptococcus pyogeues, streptococcus pneumonia- and viral infection factor-Rhinovirus, parainfluenza, Echo28, Coxsacki21, Sinusitis is complicated to allergic rhinitis, chronic otitis media purulent, chronic tonsilitis, sinubronchitis. On the condition of nasal septum deformity, turbinates deformity, nasal septum deviation, sinusitis can be developed. the predisposing factors of sinusitis is swimming, air pollution, malnutrition, shortage of immunity.2. According to survey, sinusitis occurred that children from 4 to 12 years old and from 5 to 7 years old occupied 70% 3. From the past history data, they experienced chronic tonsillar hypertropy(20%), otitis media, atopic dermatitis, allergic rhinitis, bronchial asthma, pneumonia, bronchiolitis, chronic sore throat, urticaria, milk allergy in sequence. 4. the symptoms of sinusitis is nasal obstruction, postnasal dripping, purulunt(yellow)or white discharge, cough, nose bleeding in sequence. nasal obstruction take the portion of 95%, postnasal dripping 65%, night time or early morning cough 60%. 5. The suffering period of sinusitis is 6 month minimum, 4 years maximum, most cases are included in a year. The suffering period of children was shorter than adult. 6. Diagnosis depend on inspection of nasal cavity, postnasal dripping, X-ray finding. 75% of patient(15case) showed both maxillary sinusitis, 25%(5cases) showed left or right maxillary sinusitis. 7. Treatment of oriental medicine, consist of Herb-medicine, acupuncture and exposing of Lazer beam. Kamihyunggyeyungyotang(加味荊芥蓮翹湯) is administered mainly as the medical therapy, Kamigwaghyangjeungkisan(加味藿香正氣散) Kimizwakwieum(加味左歸飮), Kamihyangsosan(加味香蘇散) is administered for a additional symptoms which occurred by influenza recurrence. Kamijeonxibackchulsan(加味錢氏白朮散) is administered to treat gastro-intestine trouble patients who have sinusitis. 8. The period of treatment is varied with patient conditions and X-ray finding. The minimal period is 35days, maximal period is 202days. So it took about 86days in average and about 50% of patient(10cases) is recovered in one or two month.

• 한국학교보건학회지
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• 제16권1호
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• pp.1-8
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• 2003

Purpose : While there have been growing concerns about the effects of Asian dusts on health, there are few studies for relationship between Asian dusts and health outcome. This study was designed to examine the perceived symptoms and behavior change of children during the Asian Dust events. Methods : We surveyed 459 students at an elementary school in Seoul, Korea from November 20th to 27th 2002. Children with parents were asked to return the completed questionnaires within a week. The questionnaires included the sociodemographic factor, previous respiratory disease, and perceived symptom, hospital visits and behavior change during the Asian dusts. Results : The majority of children reported that they restrained going out and outdoor recreational activity during the Asian dusts. The rate of children who worn the mask was 49% and 47% in second grade and fifth grade, respectively. Regarding the perceived symptom during the Asian dusts, the children in 2nd were more likely to have symptom than 5th and there were significant difference between two groups in cough, asthma symptom, dry cough, phlegm and medication for allergy or asthma symptom. In addition, children who had previous disease were more likely to change behavior in order to prevent the effects of Asian dusts. Conclusions : This study suggested that the younger children and children who had past respiratory disease were susceptible to the effect of Asian dusts. There is a need for providing public information and health education to prevent the impact of Asian dusts on health.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권4호
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• pp.253-260
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• 2015

Purpose: The aim of the present study was to investigate the clinical features and outcome of eosinophilic gastroenteritis (EGE) in children. Methods: Our study enrolled 24 children who were diagnosed with EGE from 1993 to 2014 at the Department of Pediatrics, Seoul National University Children's Hospital. The patients' clinical manifestations, treatments, and outcomes were reviewed from the medical records. Results: The mean age at diagnosis was 5.3 years. Most patients had gastrointestinal symptoms including diarrhea (54.2%) and abdominal pain (45.8%). Peripheral eosinophilia was present in 91.7% of the patients. Thirteen patients (54.2%) showed anemia, and 15 patients (62.5%) had hypoalbuminemia. EGE was classified as mucosal, subserosal, or muscular in 75.0%, 20.8%, and 4.2% of cases, respectively. Three patients showed gastroduodenal ulcers upon endoscopic analysis. A history of allergy was reported in 13 patients, including atopic dermatitis, allergic rhinitis, and asthma. Five patients (20.8%) improved with food restrictions. Among the 19 patients treated with steroids, 11 (57.9%) discontinued steroid treatment without subsequent relapse, 4 (21.1%) relapsed after ceasing steroid treatment, and 4 (21.1%) showed no response to steroids. Two patients who were resistant to steroids underwent therapeutic surgery. The presence of gastroduodenal ulcers was significantly associated with relapse and steroid resistance. Conclusion: A high suspicion of EGE is warranted when children have nonspecific gastrointestinal symptoms and peripheral eosinophilia. Most patients improved with food restrictions or steroid treatment, although one-third of patients showed a relapse or steroid resistance.

• Journal of Yeungnam Medical Science
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• 제15권2호
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• pp.325-340
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• 1998

대구의 경우 최근 지하철의 개통과 더불어 대규모 지하상가가 건설 중에 있어 지하공간 근무자의 급속한 증가가 예상되며 이에 따른 보건학적인 문제에 관한 관심과 준비가 필요하다. 이 연구는 지하상가를 중심으로 지하공간 근무자들의 건강 양상을 파악하고 지하공간 실내공기의 오염원을 추정함으로써 지하공간 생활자의 보건학적인 문제점을 규명하고 대책을 세우기 위한 자료로 활용하기 위하여 이루어졌다. 1998년 8월에 대구 중앙지하상가 근무자 130명과 대명동 지역 지상상가 근무자 60명을 대상으로 미국 국립산업안전보건원에서 개발한 실내공기오염 설문지를 이용하여 건강 및 증상(예; 천식, 알레르기질환 이환여부, 눈, 코, 목, 호흡기, 피부 동의 비특이적 증상 등), 근무환경에 관한 사항(예; 환기, 온도, 습도, 냄새 등) 및 개인적인 사항(예; 연령, 성별, 흡연유무 등)을 조사하였다. 실내공기질의 측정은 지하상가를 6개 구역으로 나누고 구역별 온도, 산소, 이산화탄소, 일산화탄소와 포름알데히드를 측정하고 기존자료를 활용하였다. 대조군에 비해 지하상가에서 근무하는 고위험군은 기관지염과 먼지알레르기를 경험한 율이 유의하게 높였다. SBS의 진단기준은 NIOSH의 기준과 동일한 지난 한 달 동안 일주일에 하루 이상 눈, 코, 목, 호흡기 동의 증상과 두통, 피로감을 한가지 이상 경험하였고 지하공간을 벗어나면 증상이 호전되는 경우로 하였다. 지난 한달 동안 경험한 증상에 관한 조사에서 눈이 건조하다, 가렵다, 따갑다, 목이 따갑거나 건조함을 느낀다, 가슴이 답답하다, 눈이 피곤하고 충혈된다 및 피부가 가렵다, 건조하다 항목에서 두 군의 유병률은 유의한 차이가 있었다. 18개의 SBS 증상 중 1주일에 1-3회 이상 경험하는 증상의 개수는 고위험군에서 대조군에 비해 유의하게 많았다. 이상의 조사 및 분석결과를 종합하면 일부 지하상가 근무자들은 지하의 제한된 공간에 장기간 근무함으로써 부적절한 인간공학적 환경, 물리적 환경, 부족한 환기량 등에 의해 실내공기 오염으로 인한 증상 경험이 대조군에 비해 유의하게 높았으며 68.5%의 지하상가 근무자가 SBS를 경험하고 있었다. 그러므로 지하공간 근무자의 SBS 발생을 예방하기 위해서는 실내공기질의 정확한 평가를 통한 예방대책 수립이 필요하다. 또 의료인의 관심을 통해 SBS의 진단, 치료 및 예방 등과 같은 적절한 의학적 조치 및 연구가 이루어져야겠으며 근무자들의 환경에 대한 교육이 필요하다고 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제57권4호
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• pp.320-328
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• 2004

연구배경 : 만성폐쇄성폐질환의 경과 중 조기에 나타나는 폐혈관의 변화는 이후 만성폐쇄성폐질환의 불량한 예후 인자인 폐고혈압증의 원인이 된다. Beraprost sodium (BPS)은 경구투여가 가능한 prostacyclin 유사 약제이며, 원발성폐고혈압 환자에서 생존율을 향상시킨다고 알려져 있다. 본 연구는 만성폐쇄성폐질환 환자에 대한 BPS의 효과에 대해 알아보고자 하였다. 연구방법 : 본 연구는 이중맹검, 무작위, 무효약대조, 2기관 임상시험이다. 2003년 6월부터 2004년 6월까지 만성폐쇄성폐질환 환자 21명이 선정되었다(이중 BPS를 3개월간 복용한 BPS군은 11명, 무효약을 복용한 무효약군은 10명). 기초평가, 폐기능검사, 혈역학적 지표에서 두 군간 통계적 차이는 없었다. 연구결과 : 심장초음파검사에서 Trans Tricuspid valve Pressure Gradient(TTPG) 측정값이 BPS군에서 BPS 복용 전보다 복용 3개월 후 현저한 감소를 보였다[17.7(${\pm}11.4$)에서 8.2(${\pm}8.9$) mm Hg, p-value<0.05]. 한편 무효약군 에서는 통계학적 차이가 없었다. 6분 도보거리는 무효약군에서는 감소를 보였고 BPS군에서는 증가된 결과를 보였으나 통계적 유의성은 없었다. 결 론 : 만성폐쇄성폐질환 환자에서 BPS의 경구복용은 폐동맥압을 감소하게 하였다. 이런 결과의 임상적 중요 성인 증상 및 질병의 자연경과의 개선을 조사하기 위한 추가연구가 필요할 것으로 사료된다.

• Clinical and Experimental Pediatrics
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• 제46권4호
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• pp.370-375
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• 2003

목 적 : 출생 후 영아기에 알레르겐에 대한 노출 여부가 추후 감작과 알레르기질환의 발생에 중요한 것으로 알려져 왔다. 우리나라에서는 집먼지진드기가 알레르기질환의 주요 흡입 알레르겐으로, 집먼지진드기 항원량은 계절적으로 가을에 가장 높은 것으로 보고되었다. 이에 저자들은 소아 호흡기 알레르기 환자에서 집먼지진드기에 대한 감작 여부에 따라서 출생 월 분포의 차이가 있는지 알아보기 위해 본 연구를 시행하였다. 방 법 : 1995년 1월부터 2002년 5월까지 만성 호흡기 증상으로 서울대학교병원 어린이병원을 방문하여 알레르기 피부단자시험과 메타콜린 유발시험을 시행 받은 환아 1,327명을 대상으로 집먼지진드기에 대한 감작 여부와 출생 월을 조사하여, 집먼지진드기 감작 유무에 따라 출생 월 분포를 비교하였다. 결 과 : 한 가지 이상의 알레르겐에 피부시험 양성을 보인 아토피군은 864명(65.1%)이고 비아토피군은 463명(34.9%)이었다. 아토피군에서 집먼지진드기에 양성을 보인 환아의 수는 787명(91.1%)이고 집먼지진드기를 제외한 나머지 피부시약에 양성반응을 보인 수는 77명(8.9%)이었다. 집먼지진드기 아토피군과 비아토피군의 출생 월별 분포를 기대 환자수와 비교했을 때 집먼지진드기 알레르기를 가진 환아들은 계절적으로 8월에서 11월까지 기대 환자수 보다 유의하게 많이 출생하였고(P=0.03) 비아토피군에서는 상기와 같은 출생 월 분포를 보이지 않았다. 천식으로 진단된 환아는 총 543명(40.9%)이었고 이중 아토피성 천식 환아는 421명(77.5%)이었고 비아토피성 천식 환아가 122명(22.5 %)이었다. 아토피성 천식 환아 중 집먼지진드기 아토피성인 환아는 387명(91.9%)이었다. 집먼지진드기 아토피성 천식과 비아토피성 천식 환아에서 출생 월의 계절별 비교에서 8월에서 11월까지 집먼지진드기 아토피성 천식 환아가 비아토피성 천식 환아보다 유의하게 많이 출생하였다(P=0.002). 결 론 : 출생 월은 알레르겐에 대한 감작 여부에 연관이 있는 것으로 보이며, 우리나라에서는 8월에서 11월까지의 출생이 집먼지진드기에 대한 감작의 위험이 큰 시기로 보인다.

• Clinical and Experimental Pediatrics
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• 제51권4호
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• pp.343-350
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• 2008

Asthma and allergic diseases are one of the most common disorders in children. Due to its increased prevalence, as well as the increased morbidity and mortality from these diseases, asthma and allergic diseases have come to be recognized as a major worldwide public health issue. In addition, socioeconomic burden of asthma and allergic diseases has increased in Korea also. The International Study of Asthma and Allergies in Childhood (ISAAC) investigated the worldwide prevalence of asthma and other allergic diseases using simple standardized methods because of the comparison of asthma and allergic diseases between the countries. In Korea, several epidemiologic studies have been conducted to determine the prevalence of asthma in children. Although these studies showed increased prevalence of asthma among Korean children (from 3.4% in 1964 to 10.1% in 1989), these findings were based on data from small numbers of subjects. The first Nationwide Study of Asthma and Allergies in Korean Children, which utilized the Korean version of ISAAC written and video questionnaire, was conducted in 1995 and the second Nationwide Study of Asthma and Allergies in Korean Children was conducted in 2000, directed by the Korean Academy of Pediatric Allergy and Respiratory Diseases. We report here the prevalence of asthma and other allergic diseases in Korean children and adolescents, and show the changes that occurred over this 5 year period. We also describe the risk factors for development of these diseases in Korean children. We developed Korean versions of the ISAAC written (WQ) and video (AVQ) questionnaires for allergic diseases. In 1995, the enrolled population consisted of 25,117 children selected from 34 elementary school and 14,946 children selected from 34 middle school across the nation, the response rate was 94.8%. In 2000, 27,831 children selected from 34 elementary school and 15,214 children selected from 34 middle school, and the response rate was 96.4%. From these studies, we can confirm that increase of the prevalences of asthma, allergic rhinitis, and atopic dermatitis in Korea, except the prevalence of food allergy. Especially, the video questionnaire showed increases in the lifetime and 12 month prevalence rates of wheeze at rest, exercise-induced wheeze, nocturnal wheeze, nocturnal cough, and severe wheeze over this period of time in middle school children. In addition, the increase of prevalences of symptoms, diagnosis and treatment of atopic dermatitis was noted significantly. Risk factor analysis showed that body mass index (BMI), passive smoking and living with a dog or cat were associated with higher risk of wheeze. Also the occurrence of fever during infancy and the frequent use of antibiotics were associated with the risk of wheeze. In conclusion, during the 5 year period from 1995 to 2000, the prevalences of asthma, allergic rhinitis, and atopic dermatitis has increased in Korean children. BMI, passive smoking, living with a dog or cat, the fever episodes in infancy, and the frequent use of antibiotics in infancy are important risk factors to development of asthma and atopic dermatitis. In the near future, the birth cohort study will be needed to investigate the causes of this increase and the natural course of allergic diseases, then we develop the methods to control asthma and allergic diseases.

• 동의생리병리학회지
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• 제32권4호
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• pp.255-260
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• 2018

Chung-Sang (CS) is an experimental herbal remedy that is formulated to treat respiratory diseases implicated by inflammation. The herbs comprised of CS are frequently prescribed for treating various inflammatory symptoms: Menthae haplocalycis Herba, Magnoliae Flosis, Xanthii Fructus, Herba Asari, and Caryphylli Flos. Here, we prepared the extract of CS with boiling water (wCS) or with 50 % ethanol (eCS) and examined whether the two different extracts of CS exhibit a toxicity to cultured cells and mice. RAW 264.7 cells were treated with wCS or eCS, and the cytotoxicity of these extracts to RAW 264.7 cells was determined by an MTT assay. Although the production of intracellular reactive oxygen species that are detrimental to the cells was not increased by the extracts, the cytotoxicity to the cells was evident from 10 mg/ml of wCS and 100 mg/ml of eCS, suggesting that eCS is less cytotoxic. When mice (n = 10/group) received a single intratracheal wCS or eCS daily for 14 days, wCS yielded 40 % mortality, whereas eCS showed none. Both wCS and eCS did not significantly affect the weight of the body and of vital organs, except the lung. Biochemical analyses of mice blood indicated no damage to liver or kidney. However, unlike eCS, wCS significantly increased the level of IgE in serum. Collectively, our results show that eCS was less toxic than wCS, suggesting that CS prepared with 50 % ethanol is preferential over the conventional way of preparing CS.