Evaluation of PPD skin test positivity in childhood tuberculosis

의학과/석사[한글] 우리 나라가 최근 경제적 사회적 및 문화적인 면에서 급속한 향상을 이룩함에 따라 결핵은 점차 많은 감소를 보이고 있기는 하나 아직도 선진국보다 높은 유병율을 보이고 있고 후진성 질환인 결핵이 많은 시점에서 국민들의 경각심이 낮아져 가고있는 상태이다. 특히 결핵에 이환될 위험이 높은 집단에 대해서는 깊은 관심을 가져야 하겠는데 이러한 집단중의 하나가 소아집단이다. 소아의 결핵은 초감염결핵으로서 결핵반응검사에 양성으로 나타나는 것은 병을 진단하는데 매우 중요한 근거로 되고있다. 그러나 이 검사는 특히 위음성으로 나타날 가능성이 많아 결핵질환을 오진하게 되는 일이 대단히 많다. 이에 저자는 우리 나라의 소아결핵 환자에 있어서 결핵반응 양성률이 얼마나 되는지를 알아봄으로서 결핵환자를 진단하는데 도움이 되도록 본 연구를 실시하였다. 소아결핵 환아 150명을 대상으로 하여 결핵반응 양성 또는 음성률을 나이, 성별, 이환부위 등으로 분류한 뒤 다음과 같은 결과를 얻었다. 1. 대상환아의 연령 및 성별분포를 살펴보면 1세 미만에서 19명(12.7%), 1세부터 6세미만이 59명(39.3%), 6세부터 10세 미만이 37명(24.7%), 10세부터 15세 미만이 35명(23.3%)이었으며 남아는 93명(62.0%), 여아는 57명(38.6%)으로 1.6 : 1의 비율로 남아에서 더 많이 발생하였다. 2. 대상환아 150명을 질병형태와 연령별로 분류하면 폐결핵이 43례(34.4%)로 가장 않았고 골관절결핵 23례(15.37), 결핵성뇌막염1977(12.7%), 결핵성늑막염 19례(12.7%), 기관 지내결핵 16례(10.7%), 경부임파절결핵 11례(7.3%), 복부결핵 8례(5.3%), 속립성결핵 4례(2.7%) 등의 순이었다. 1세 미만에서는 폐결핵이 많았으며 1세부터 6세 미만에서는 폐결핵과 골관절결핵이 다수를 차지하였고 6세부터 10세 미만에서는 폐결핵과 결핵성늑막염 및 결핵성뇌막염이 다수를 차지하였으며 10세부터 15세 미만에서는 폐결핵이 가장 많았다. 3. 대상환아 150명 중 50명(33.3%)에서 가족 내에서 감염이 있었으며 부모가 감염된 35명 중 10세미만이 26명으로 나이가 어릴수록 부모가 중요한 역할을 한다고 추정할 수 있다. 4. 대상환아 150명 중 B.C.G를 접종받은 환아는 102명(68.0%), 비접종환아는 18명(12.0%)이었고 30명(20.0%)에서는 접종여부가 확실하지 않았다. 5. 대상환아 150명 중 5TU PPD 반응검사 결과 양성인 환아는 95명(63.3%), 음성인 환아는 55명(36.7%)이었으며 1TU PPD 반응검사에서 150명의 환아 중 57명(38.0%)에서 양성 반응을 나타냈고 93명(62.0%)에서 음성반응을 보였다. 6. 병류별 5TU PPD 반응검사 결과에서는 경부임파절결핵 환아 11명 중 9명(81.8%)에서 양성반응을 보여 가장 높았으며 골관절결핵 환아들은 23명 중 18명(78.3%), 폐결핵 환아들은 43명중 24명755.8%), 결핵성늑막염과 결핵성뇌막염 환아들은 각각19명 중 13명(68.4 %), 기관지내결핵 환아들은 16명 중 8명(50.0%), 복부결핵 환아들은 8명 중 4명(50.0%)에서 양성반응을 보였으며 속립성결핵 환아들은 4명 중 1명에서만 양성반응을 보였다. 1TU PPD 반응검사 결과에서는 경부임파절결핵 환아는 11명중 1명(9.1%)에서만 양성반응을 보 였고 골관절결핵과 결핵성뇌막염에서도 각각 26.1%와 31.6%의 양성률을 보여 5TU PPD 반응검사와 많은 차이가 있다. 7. 대상환아 150명 중 1TU PPD가 양성반응일 때 5TU PPD가 양성반응으로 나을 확률은 57명 중 56명으로 98.2%이었으며 5TU PPD가 양성반응일 때 1TU PPD가 양성반응일 확률은 95명 중56명으로 58.9%이고 1TU PPD가 음성반응일 때 5TU PPD가 양성반응일 화률은 95명 중 39명으로 41.1%이었다. 결론적으로 결핵을 진단하는데 있어서 PPD 반응검사 결과는 아직까지 중요한 의미를 갖고 있지만 이 검사는 결핵환자에서도 양성반응의 빈도가 낮기 때문에 전적으로 PPD 반응 검사 결과에 의존만 하여서는 안될 것이며 5TU PPD 반응검사는 ITU 반응검사보다는 더 신빙성이 높은 검사라고 생각된다. Evaluation of PPD skin test positivity in childhood tuberculosis Kyoung Hoon Choi Department of Medical Science, The Graduate School, Yonsei University (Directed by Professor Ki Young Lee, M.D.) Childhood tuberculosis is predominantly primary tuberculosis, and the positive reaction to the PPD skin test is important in diagnosing tuberculosis. But a false positive or false negative reaction may occur. This study was designed to evaluated the PPD positive reaction rate in childhood tuberculosis. I evaluated 150 tuberculosis patients. The results were as follows : 1. According to the distribution of age and sex, there were 19 patients(12.7%) below 1 year and 59 patients(39.3%) between 1 year and 6 years, 37 patients(24.7%) between 6 years and10 years, 35 patients(23.3%) between 10 years and 15 years. 2. Pulmonary tuberculosis is predominant below 1 year, and pulmonary tuberculosis and bone and joint tuberculosis were predominant between 1 year and 6 years. Pulmonary tuberculosis is predominant over 6 years of age 3. In tuberculosis patients with contact history, the parent is predominant. 4. Of the 150 patients, 102 patients(68.0% ) were vaccinated with B.C.G. 5. Of the 150 patient$with confirmed PPD skin test results, 95 patients(63.3 were positive in 5TU PPD and 57 patients(38.0 positivity increased with age. 6. Of the 11 cervical lymphadenopathy, 9 patients(81.8 the 23 bone and joint tuberculosis patients, 18 patients(78.3 the 43 pulmonary tuberculosis patients, 19 patients(55.8 tuberculous pleurisy and 19 tuberculous meningitis patients, 13 patients(68.4 were positive in each group. Of the 16 with endobronchial tuberculosis, 8 patients(50.0 were positive. Of the 4 with miliary tuberculosis, only 1 patient was positive. The PPD skin test is important in diagnosing tuberculosis, but the test is not a confirmative method as the positive reaction is low even in patients with tuberculosis. It seems to have more diagnostic value of 5TU PPD than 1TU PPD. [영문] Childhood tuberculosis is predominantly primary tuberculosis, and the positive reaction to the PPD skin test is important in diagnosing tuberculosis. But a false positive or false negative reaction may occur. This study was designed to evaluated the PPD positive reaction rate in childhood tuberculosis. I evaluated 150 tuberculosis patients. The results were as follows : 1. According to the distribution of age and sex, there were 19 patients(12.7 2. Pulmonary tuberculosis is predominant below 1 year, and pulmonary tuberculosis and bone and joint tuberculosis were predominant between 1 year and 6 years. Pulmonary tuberculosis is predominant over 6 years of age 3. In tuberculosis patients with contact history, the parent is predominant. 4. Of the 150 patients, 102 patients(68.0 5. Of the 150 patient$ with confirmed PPD skin test results, 95 patients(63.3%) were positive in 5TU PPD and 57 patients(38.0%) were Positive in 1TU PPD. The PPD positivity increased with age. 6. Of the 11 cervical lymphadenopathy, 9 patients(81.8%) were positive ; and of the 23 bone and joint tuberculosis patients, 18 patients(78.3%) were positive. Of the 43 pulmonary tuberculosis patients, 19 patients(55.8%) were positive. Of the 19 tuberculous pleurisy and 19 tuberculous meningitis patients, 13 patients(68.4%) were positive in each group. Of the 16 with endobronchial tuberculosis, 8 patients(50.0%) were positive ; and of the 8 abdominal patients, 4 patients(50.0%) were positive. Of the 4 with miliary tuberculosis, only 1 patient was positive. The PPD skin test is important in diagnosing tuberculosis, but the test is not a confirmative method as the positive reaction is low even in patients with tuberculosis. It seems to have more diagnostic value of 5TU PPD than 1TU PPD.restrictio

Ex-situ Reductive Dechlorination of Carbon Tetrachloride by Iron Sulfide in Batch Reactor

Ex-situ reductive dechlorination of carbon tetrachloride (CT) by iron sulfide in a batch reactor was characterized in this study. Reactor scaled-up by 3.5 L was used to investigate the effect of reductant concentration on removal efficiency and process optimization for ex-situ degradation. The experiment was conducted by using both liquid-phase and gas-phase volume at pH 8.5 in anaerobic condition. For 1 mM of initial CT concentration, the removal of the target compound was 98.9% at 6.0 g/L iron sulfide. Process optimization for ex-situ treatment was performed by checking the effect of transition metal and mixing time on synthesizing iron sulfide solution, and by determining of the regeneration time. The effect of Co(II) as transition metal was shown that the reaction rate was slightly improved but the improvement was not that outstanding. The result of determination on the regeneration time indicated that regenerating reductant capacity after 1st treatment of target compound was needed. Due to the high removal rates of CT, ex-situ reductive dechlorination in batch reactor can be used for basic treatment for the chlorinated compounds.The Korea Ministry of Land, Transport and Maritime Affairs (07-UR-B04: High-tech Urban Development Program) and Korea Research Foundation (KRF- 2007-313-D00439

Changes in service area of Wonju christian hospital for the past 8 years

의학과/석사[한글] 최근 경제성장과 더불어 국민 생활수준이 향상되었고 정부의 사회보장정책에 의한 의료보험이 1977년부터 단계적으로 실시되었으며, 제5차 5개년 경제사회발전 계획이 종료되는 1986년에는 국민의료보험 가입율이 증가될 것이 예상된다. 이에따라 각 의료기관은 증가되는 의료수요를 감당하기 위하여 시설확대에 주력하게되며 체계적인 병원계획이 절실히 요망되고 있다. 병원계획의 첫 단계는 병원의 진료권을 설정하는 작업으로서 진료대상 인구와 의료수요를 추정하는 데에 있다. 본 연구는 1974년부터 1981년까지 연세대학교 의과대학 원주기독병원의 의무기록을 분석하여 환자원조사 방법을 사용하여 동 병원의 진료권을 설정하고 그 변화를 관찰하여 향후 원주기독병원의 체계적인 병원계획 수립의 기본자료를 제시하고자 하였다. 진료권은 거주지역별로 외래 및 입원환자구성비 ( commitment index)를 사용하여 설정하였으며 동 병원의 진료권내 주민 1,000명당 병원이용율을 조사하고 그 변화를 관찰하여 다음과 같은 결과를 얻었다. 1. 조사대상 병원의 진료권은 원주를 중심으로 인근지역의 2개 시 6개 군으로서 원주시, 횡성군, 원성군, 제천시, 영월군, 정선군, 평창군, 단양군으로 설정하였다. 2. 1979년 이후 강원도 지역의 외래환자수는 점차 증가하였으나 충청북도 및 경기도 지역의 환자수는 감소하였다. 그러나, 입원환자는 진료권내 전 지역에서 증가하였으므로 의료인력 및 의료시설을 확장시켜서 늘어나는 의료수요에 대비해야 할 것으로 생각한다. 3. 조사대상 병원의 진료권은 시간이 경과함에 따라 축소하는 경향을 보여 앞으로 진료의 질적 향상을 도모하여 1차 진료권 이외의 지역환자에 대한 의료써비스에 주력해야 할 것으로 생각된다. 4. 환자의 병원이용율은 전반적으로 증가하였으며 지역적으로는 외래환자의 경우는 강원도 이외의 지역은 감소하였고, 입원환자의 경우는 경기도 지역이 감소하였으므로 앞으로 경기도 지역은 본 병원의 진료권에서 제외될 가능성이 많다. Changes in Service Area of Wonju Christian Hospital for the past 8 Year Kyung Hoon Choe Department of Medical Science The Graduate School Yonsei University (Directed by Professor ll Soon Kim, M.D.) The study was conducted to provide necessary Information for the future expansion plan of the Wonju Christian Hospital by defining its service area and utilization pattern of past eight years. The study included 1) patient origin study, 2) changes in utilization pattern, and 3) boundary of the primary service area based on the hospital statistics from 1974 through 1981. The commitment index was used for the definition of the service area of the hospital. Population based utilization rates were produced for the analysis of utilization patterns of the service area. The data was retrieved from the hospital`s medical records, analyzed and prioritized by the magnitude of the utilization of each subareas. The summary of the study is; a. The Hospital`s primary service areas were identified as 8 districts: Wonju, Wonsung, Hoengsung, Chechon, Youngwol, Jungsun, Pyungchang and Danyang. b. Since 1979 the outpatient has significantly increased are as in Kangwon-Do, and has decreased in the other surrounding areas. However the inpatient has increased in all areas including Kangwon-Do, Choongchung-Pook-Do and Kyunggi-Do. This pattern might indicate a similar tendency in the future. c. The Hospital`s boudary of primary service area has been gradually decreased. d. Utilization rates per 1,000 population were increased in the entire service areas. It is concluded that the hospital may consider expansion of service capacity to meet the present meet the present need/demand, and further consider providing high quality health care for the dependent population in the secondary service area, that has been the primary service area in the earlier days of the hospital. [영문] The study was conducted to provide necessary Information for the future expansion plan of the Wonju Christian Hospital by defining its service area and utilization pattern of past eight years. The study included 1) patient origin study, 2) changes in utilization pattern, and 3) boundary of the primary service area based on the hospital statistics from 1974 through 1981. The commitment index was used for the definition of the service area of the hospital. Population based utilization rates were produced for the analysis of utilization patterns of the service area. The data was retrieved from the hospital`s medical records, analyzed and prioritized by the magnitude of the utilization of each subareas. The summary of the study is; a. The Hospital`s primary service areas were identified as 8 districts: Wonju, Wonsung, Hoengsung, Chechon, Youngwol, Jungsun, Pyungchang and Danyang. b. Since 1979 the outpatient has significantly increased are as in Kangwon-Do, and has decreased in the other surrounding areas. However the inpatient has increased in all areas including Kangwon-Do, Choongchung-Pook-Do and Kyunggi-Do. This pattern might indicate a similar tendency in the future. c. The Hospital`s boudary of primary service area has been gradually decreased. d. Utilization rates per 1,000 population were increased in the entire service areas. It is concluded that the hospital may consider expansion of service capacity to meet the present meet the present need/demand, and further consider providing high quality health care for the dependent population in the secondary service area, that has been the primary service area in the earlier days of the hospital.restrictio

(The) morphometric study of th

의학과/박사[한글] 고추에서 매운 맛을 내는 성분인 capsaicin은 투여 초기에 통증을 유발 한 후 나중에는 진통효과를 나타낸다. Capsaicin을 신생 흰쥐에 투여하면 성숙 흰쥐에서 통각전달섬유가 크게 감소하며, 통증에 대한 감수성도 크게 저하된다. 현재까지 capsaicin 연구의 대부분은 신생 흰쥐에 capsaicin을 투여한 후 성숙하기를 기다린 후에 그 효과를 본 것으로서, 투여 후 바로, 또는 단기간의 시간이 경과한 후의 변화를 체계적으로 분석한 형태학적인 연구는 거의 없으며, 특히 통각전달에 관여하는 것으로 알려진 신경펩타이드인 substance P와 calcitonin gene-related peptide (CGRP)에 관한 연구는 전혀 없다. 아직 명확하게 알려지지 않고 있는 capsaicin투여 직후의 변화를 규명하기 위해 신생흰쥐에 capsaicin을 투여한 후 3시간, 24시간, 3일, 1주일 경과한 다음 척수신경절의 T12, L5 신경절에서 substance P 및 CGRP함유 신경원의 수와 면적을 면역조직화학적 방법과 형태계측학적 방법으로 조사하고, 전자현미경 관찰을 통해 미세 구조의 변화 양상을 연구하여 다음과 같은 결과를 얻었다. 1. 대조군에 비해 capsaicin 투여군에서 substance P 양성세포와 CGRP 양성세포의 수는 24시간까지는 큰 변화를 보이지 않았으나, 3일부터는 현저하게 감소하였다. 2. 감소의 정도는 T12와 L5 척수신경절에서 3일가지는 유사한 양상으로 나타났으나, 1주일후에는 L5의 변화가 더 크게 나타났다. 3. Capsaicin 투여 후 세포의 크기는 대조군에 비해 점차적으로 증가하는 양상을 보였으며, 1주일 후에는 통계적으로 유의하게 큰 세포가 많았다. 4. 전자현미경 관찰에서 축삭의 퇴행성 변화는 capsaicin 투여 24시간 후부터 뚜렷하게 관찰되었다. 5. Capsaicin 투여 후 유수신경섬유는 거의 파괴되지 않았다. 이상의 결과로 보아 capsaicin은 투여 24시간 후부터 substance P와 CGRP를 함유한 작은 신경원을 파괴시키고, 무수축삭의 퇴행성변화를 유발하는 반면 유수신경섬유에는 별다른 변화를 일으키지 않는다. 시간적으로 capsaicin 투여 3시간까지는 큰 영향이 나타나지 않지만 전자현미경에서는 24시간 후부터, 면역화학 염색에서는 3일 이후부터 뚜렷한 변화가 나타났다. [영문] Capsaicin, the pungent ingredient in a wide variety of red peppers of the genus Capsicum, strongly excites peripheral nociceptors on initial administration, but desensitization of pain occurs for a long period thereafter. Administration of capsaicin to adult animals reversibly desensitizes the pain conducting fibers, while administration of capsaicin to newborn animals results in a lifelong insensitivity to pain with selective and permanent degeneration of small diameter primary sensory neurons, including small B type neural cell bodies in the dorsal root ganglia (DRG), their terminals in the spinal dorsal horn, and their unmyelinated C and small myelinated Aδ fibers. Moat research on the effects of neonatal capsaicin has been conducted in adult rats, and reports of the immediate effects of neonatal capsaicin were rarely found, especially those on the substance P and calcitonin gene-related peptide (CGRP),known as pain conducting neurotransmitters, of the DRG. The purpose of this study was to investigate the changes immediately or shortly after capsaicin administration on substance P and CGRP immunoreactive DRG. Forty Sprague-Dawley rats from 5 different batches were used for this study. Capsaicin dissolved in vehicle containing 1:1:8 solution of Tween 80, ethanol and saline,50 mg/kg was injected subcutaneously to 20 neonatal rats. Only vehicle was injected in 20 control rats. Animals were sacrificed 3 hrs, 24 hrs, 3 days, and 7 days after capsaicin or vehicle injection. T12 and L5 DRG specimens were processed for immunohistochemical staining with substance P and CGRP antibodies. Some specimens were processed for electron microscopy. The results were as follows; 1. Substance P and CGRP immunoreactive DRG cell counts were unchanged until 24 hrs but were reduced 3 days after capsaicin administration. 2. L5 neuron counts were reduced more than those of T12 ganglia 1 week after capsaicin administration. 3. Cell size of capsaicin treated DRG neurons were larger than those of controls. 4. Significant axonal degeneration in DRG was evident 24 hours after capsaicin administration in electron microscopic observation. 5. Myelinated fibers were spared throughout the entire course of capsaicin treatment. In conclusion, capsaicin effects in DRG were evident 24 hrs after capsaicin administration compared to vehicle injected control rats. Substance P- and CGRP-immunoreactive neurons were reduced 3 days after capsaicin administration. Myelinated fibers were spared throughout the entire course of capsaicin treatment.restrictio