전자부품 제조업 근로자들의 시력변화에 대한 연구

이용만,안규동,이성수,함정오,김화성,리갑수,이병국 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

근접작업이 시력약화의 원인이 될 수 있는가를 알아보기 위하여 전자부품을 제조하는 2개 사업장에서 1991년에서 1993년까지 입사한 근로자들 중에서 근접작업으로 인정되는 마이크로칩을 조립하는 근접작업자 306명을 조사군으로, 대조군은 세탁기 타이머 및 일반 기계기구를 조립하는 작업자 154명, 계 460명을 선정하였다. 이들 대상자는 1991년 입사자는 1993, 1994, 1995년 시력을 조사하였으며, 1992년 입사자는 1993, 1994, 1995년 3년동안 조사를 하였으며, 1993년 입사자는 1994, 1995년 2년간 시력을 조사하였다. 대상자 중에서 입사시 안경을 착용한 근로자는 82명(17.8%)이었다. 따라서 남자 근로자와 안경착용자를 제외한 여성 근로자들 335명만을 추적 조사하여 다음과 같은 결론을 얻었다. 조사군에서 입사시 시력 1.0 이상이었던 근로자의 분포는 취업 1년 후 약 25-35% 정도 감소하였으며, 2년후에는 약 40-60% 정도의 감소를 나타내었고, 3년 후 약 50-65% 정도로 감소하였고 4년후에는 약 65% 이상 감소하였다. 그러나 대조군에서는 1.0 이상의 시력을 보였던 근로자들의 비율이 취업 1년 또는 2년 후 15-30%의 감소를 보이고 있으나 그 이후에는 큰 변동이 없었다. 이들의 시력변화를 근무년수에 따라 알아보기 위하여 조사된 시력을 순위변수로 하여 Kruskall-Wallis 검정을 시행한 결과 조사군, 대조군 모두에서 근속년수에 따른 순위의 합의 평균이 년차적으로 유의하게 감소하였으나, 입사시부터 근속년수에 따른 조사군과 대조군과의 순위합의 평균에 의한 시력차 비교에서 입사시 조사군의 순위합의 평균이 유의하게 높았던 것이 근무기간에 따라 대조군의 평균이 높아지면서 통계적 유의성이 없고 대체적으로 1년 이후부터 변화가 적은 것으로 나타나 근접작업으로 인한 시력약화를 추정할 수 있었다. This study was carried out to investigate that the close distance works were associated with decreased visual acuity. 306 workers were subjects who had been recruited from 1991 to 1993 in two electronic parts manufacturing factories, and 154 workers were controls who had been employed from 1991 to 1993 in launder machine timer and general machine assembly factories. Subjects who had been employed in 1991 and 1992 were follow up from 1993 to 1995, and subjects who had been employed in 1993 were from 1994 to 1995. The male workers as well as glasses wearing workers were excluded. Only 335 female workers were followed up to study the change of visual acuity. The results were as follows; The rate of workers with visual acuity over 1.0 at recruit year in subjects group was decreased about 25-35% after 1 year, 40-60% after 2 years, 50-65% after 3 years, and 65% after 4 years. While, the rate of workers with visual acuity over 1.0 at recruit year in control group was decreased about 15-30% after 1 or 2 years, and there was no more additional visual acuity reduction after then. Kruskall-Wallis test was performed to investigate the change of visual acuity in subject and control group by work duration. The means scores of ranks in both group were significantly decreased by work duration. The mean scores of ranks in subject group at recruit year were significantly higher than those in control group at recruit year, but these differences were disappeared after 1 year work. Therefore, this suggest that close distance workers may be affected their visual acuity.

Clinical Characteristics and Treatment Outcomes of Chronic Pulmonary Aspergillosis: a Retrospective Analysis of 70 Patients

( Byung Woo Jhun ),( Kyeong Man Jeon ),( Jung Seop Eom ),( Ji Hyun Lee,),( Gee Young Suh ),( Man Pyo Chung ),( O Jung Kwon ),( Won Jung Koh ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Backgroud: Chronic pulmonary aspergillosis (CPA) is uncommon and there are few data on the clinical characteristics, optimal therapeutic strategies, and outcomes. Methods: We retrospectively reviewed the records of patients with newly diagnosed CPA and assessed the clinical, radiologic, and laboratory responses, and outcomes between January 2008 and January 2012. Results: A total of 70 CPA patients were included. Median age was 55 years and 51 patients (72.9% ) were men. Fifty-seven patients (81.4%) had a history of pulmonary tuberculosis and 32 patients (45.7%) had non-tuberculosis mycobacterium (NTM) lung disease, 17 of whom had a history of NTM treatment and 15 was under NTM treatment. Sixty-nine patients (98.6%) received oral itraconazole, except one with oral voriconazole for a median duration of 6.2 months. Symptomatic improvement occurred in 52 patients (74.3%), radiologic improvement occurred in 29 (41.4%), and laboratory tests improved more than 60% of all patients. Thirty-six patients (51.4%) achieved treatment success, defined as symptomatic improvement after at least 6 months of therapy regardless of radiological improvement, and 4 of whom needed retreatment after a median of 8.4 months. There was no difference in clinical characteristics and outcomes according to NTM status and 10 (14.3%) discontinued therapy due to adverse reactions. Death occurred in 10 (14.3%) and median follow-up duration was 11.2 months. Conclusion: Antifungal therapy for about 6 months and reassessment of disease might be feasible treatment strategy in managing patients with CPA.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

腦硬塞을 同伴한 糖尿病性 腎症 患者에 對한 一例報告

이지영,김만호,최병렬,이정원,조충식 대전대학교 한방병원 2001 惠和醫學 Vol.10 No.1

A clinical study was done in one case of Diabetic Nephropathy patient for Oriental Medicien Hospital of DaeJeon Univeristy one month, Dec 1-30, 2001. The following results were obtained. Patient, 60 years old man had complained tibia edema, itching sense, an early uremia and Rt. Hemiparesis. After treatment of Acupuncture and Moxibustion and Herbmed with physical therapy during about one month, patient could self working with assistance and showed improvedment of chief compalin and uremia.

ISFET의 제조공정 및 그 동작특성

이광만,서화일,손병기 경북대학교 센서기술연구소 1990 센서技術學術大會論文集 Vol.1 No.1

ISFET's fabrication process have been designed and computer simulated with SUFREM-II, and their results are good agreement with each other. ISFET chip has been fabraicated by using the ISRC's standard "3um CMOS process". A two-step TCA oxidation for the gate oxide and multilayer encapsulation using silicone rubber was specially used for the improvement of the stability of the ISFETs. The C-V measurement of gate oxide and the AES analysis of gate nitride were performed.The measured sensitivities of the pH-ISFETs are 43 mV/pH and 54 mV/pH without and with HF treatment, respectively.

집중하중을 받는 변단면 보의 정적거동해석

이병구,모정만 圓光大學校大學院 1992 論文集 Vol.10 No.-

An analytical method was developed to tapered beams subjected to concentrated loads. The rectangular cross-section with constant width and variable depth, so-called depth taper, was chosen. The differential equation of deflected beams based on the small deflection theory was derived and solved by indefinite integration. The unknown parameters and integral constants were calculated by the boundary conditions. The hinged-hinged. hinged-clamped, clamped-clamped and clamped-hinged beams were considered in the numerical examples. As the results of this study, the reaction moments of left ends, the vertical reactions of left ends, the maximum deflections and the maximum stresses versus nondimensional position of concentrated load were presented in figures. Also both typical bending moment diagrams and deflection curves were presented in figures. It is expected that the results of this study including both all equations and figures can be used in design of the tapered beams.

퍼지 소속 함수를 이용한 불변 패턴 인식

이금석,방만원,김병기 木浦大學校 情報産業硏究所 1996 情報産業硏究誌 Vol.4 No.-

신경망 모델을 이용한 패턴인식 시스템에 대한 연구 부문에서 패턴의 이동,크기,회전등의 변형에 대한 불변 인식문제를 해결하기 위하여 삼각형의 특성을 이용한 삼차 신경망 모델이 제안된 바 있다. 기존의 모델에서는 삼각형의 특성값(이심율)의 클래스 분할로부터 패턴에대한 특성 백터를 추출하였으나, 기존의 분할에 의한 특성 백터 추출 방법에서는 동일 클래스에 속한 두개의 서로다른 삼각형 패턴을 분별하지 못하고, 클래스 경계에 놓인 삼각형 패턴에 대한 이식율이 떨어지게 되는 단점이 있었다. 본 논문은 기존의 분할 특성 백터 추출 방법의 문제점을 해결하기 위하여 , 퍼지 소속 함수를 적용한 퍼지특성 벡터 추출 방벙을 제안하였다.

석면관련 폐질환의 진단에 있어서 흉부고해상도전산화단층촬영검사(HRCT)의 유용성

이현재,손지언,,홍영습,,이영일,예병진,유창훈,정갑열,김상훈,임형준,장은철,김정만,김준연 大韓産業醫學會 2006 대한직업환경의학회지 Vol.18 No.2

목적: 석면에 노출된 근로자에서 석면관련 폐질환의 양상을 분석하고 진단에 있어 HRCT의 유용성을 연구하여 석면에 대한 의학적 감시프로그램의 개발에 기여하고자 하였다. 방법: 석면에 직접 노출되는 작업자 68명과 간접 노출되는 작업자 94명 등 총 162명에 대해 OSHA 석면 표준, 의학적 감시 프로그램에 따라 단순 흉부방사선검사, 폐활량검사 및 우리나라 실정에 맞게 일부 수정한 의학적 설문지를 통해 면접조사의 방식으로 환자에 관한 정보를 수집하였으며, 자료의 신뢰성을 확보하기 위하여 면접조사는 1달 이상의 기간을 두고 2차례에 걸쳐 실시된 후 확인, 수정하였다. 또한, 석면관련 폐질환을 확진하기 위하여 HRCT를 추가적으로 실시하였다. 결과: HRCT결과 석면관련 폐질환의 유병율은 162명의 근로자중 17명으로 10.5%였는데, 직접 노출군에서 10명 (14.7%), 간접 노출군에서 7명 (7.4%)이었다. HRCT와 비교할 때 단순 흉부방사선검사의 민감도와 특이도는 각각 70.6%와 98.6%이었고, 양성 예측도와 음성 예측도는 각각 85.7%와 96.6%으로, HRCT는 단순흉부방사선검사에 비해 민감도가 높아 초기 석면관련 폐질환을 진단하는데 효과적이었다. 석면관련 폐질환의 진단에 있어 HRCT와 폐활량검사 사이에 유의한 관련성이 관찰되었다. HRCT 결과 석면관련 폐질환의 유무와 의학적 설문조사 결과의 빈도분석을 실시한 결과, 유의한 변수는 작업기간, 흡연량, 호흡기질환의 과거력, 기침, 호흡곤란이었다. 결론: HRCT는 석면관련 폐질환의 진단에 있어 단순 흉부방사선검사와 비교하여 민감도가 높아 초기 진단에 유용하므로 단순 흉부방사선선검사 결과 석면관련 폐질환소견을 보일 때뿐만 아니라, 정상소견을 보이더라도 폐활량 검사결과와 근무력, 흡연력, 호흡기질환의 과거력, 기침, 호흡곤란 등의 호흡기 증상을 참고하여 HRCT검사를 고려해야 한다. 또한, 본 연구에서 관련성이 없었던 요인들에 대해서도 향후 연관성을 규명하는 광범위한 전향적 연구가 필요하다. Objectives: This study was carried out to improve the medical surveillance program of workers exposed to asbestos by examining the usefulness of High Resolution Computed Tomography (HRCT) in the diagnosis of asbestos-related lung disease. Methods: The study subjects comprised 162 workers in a ship-repairing yard, 68 of whom had been directly exposed to asbestos and 94 indirectly exposed. The 'Occupational Safety & Health Administration (OSHA) asbestos standard, medical surveilance program' and HRCT were conducted to analyze the aspects of the asbestos-related lung disease. The OSHA asbestos standard, medical surveilance program consists of simple chest x-ray, spirometry and medical questionnarie. Results: Seventeen (10.5%) of the 162 subjects, 10 (14.7%) directly exposed and 7 (7.4%) indirectly exposed, revealed asbestos-related lung disease on HRCT. The sensitivity and specificity of simple chest x-ray for asbestos-related lung disease were 70.6% and 98.6%, and the positive and negative predictive values were 85.7% and 96.6% respectively, as compared with HRCT, HRCT was an effective diagnostic tool especially to detect early asbestos-related lung disease. The study results indicated a relative significant association between the results of spirometry and HRCT. The variables significantly associated with asbestos-related lung disease on HRCT were work duration, smoking history (pack-years), past history of respiratory disease, cough and dyspnea. Conclusions: In the diagnosis of asbestos-related lung disease, HRCT should be considered not only for workers with positive findings on simple chest x-ray, but also workers with specific findings on spirometry, occupational history, smoking history, and past history of respiratory disease, or with respiratory symptoms such as cough and dyspnea.

비 직업적인 연폭로자들에서의 연흡수 및 중독지표들 사이의 상호 관계

이병국,김정만 가톨릭대학산업의학센타 산업의학연구소 1983 韓國의 産業醫學 Vol.22 No.3

In order to evaluate the interrelationships between parameters indicative of lead absorption and intoxication in non-occupationally lead exposed subject, we examined lead in blood(PbB), lead in urine(PbU),?-aminolevuilnic acid in urine(ALAU)and coproporphyrin in urine(CPU) of 109 subjects who were admitted to the hospitals or visited the outpatient clinics with the clinical impression of lead poisoning without any occupational history of lead exposure. The results obtained were as follows: 1. If ALAU of 5 mg/1 and CPU of 150μg/1 were selected as response level in the doseresponse effects of lead on hematopoietic system, about 50% of subjects whose PbB were in the range of 30-40μg/dl showed positive responses. On the other hand if ALAU of 10mg/1 and CPU of 300μg/1 were selected as response level, 30% of subjects whose PbB were in the range of 50-60μg/dl showed positive responses. 2. If an ALAU of over 10mg/1 and CPU of over 300μg/1 are considered as an unacceptable limit, the present study suggested that a PBb of 50-60μg/dl would be the practical limit for biological monitoring. 3. The interrelatinoship between PbU or ALAU or CPU was better explained either by a segmental straight function or second degree regression rather than simple straight regression.

톨루엔 디이소시아네이트 폭로 근로자들의 작업방법에 따른 대사물질의 비교 및 면역능에 관한 연구

이수일,조병만,황인경,이철호,박정래 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.3

Following recent advanced industrialization, the amount of polyurethane to use as thermal insulating materials, upholstery, mattresses and packing materials in automotive and furniture industry is increasing world-widely, and the number of polyurethane-producing worker will be increased. Because the numerous organic solvents are used in polyurethane-producing factory, the workers in this work site is exposed to many organic solvents. Of the organic solvents, Toluene Diisocyanate(TDI) has many hazardous effects to human. The effects of TDI on human are the irritation to respiratory mucosa and gastrointestinal symptoms. Conjunctival irritation, dermal inflammation (redness, pain, vesicular formation) and gastrointestinal symptom(nausea, vomiting. abdominal pain) are reported just after short-term exposure of TDI. TDI is known to give rise to bronchial asthma, as the immune disorder. And because of strongly volatile characteristics of TDI, it is suggested as a more injurious material to human health, especially human immune system, than other organic solvents. Bronchial asthma inducing mechanism of TDI is not clearly known, but on the analogy of TDI induced symptoms and recent studies, early-onset asthma is type I hypersensitivity reaction mediated by immunoglobulin E(IgE), and late-onset asthma is maybe type III hypersensitivity reaction by circulating IgG. And we know that the complicated human immune function is likely to move in such that mechanisms, there are not studies on immune indices evaluating the bronchial asthma-related immune function. The evaluation of change patterns of humoral immunity including IgE and IgG and cellular immunity including T-helper cell. T-suppressor cell and T-cytotoxic cell will be helpful to evaluate exposure degrees and prognosis in TDI exposed workers. Because TDA(toluene diamine) as a biological exposure index of TDI becomes the focus of interest, we know that a study on the correlation between urinary TDA and air TDI and immunological indices will make a contribution to biological effect monitoring indicies. We examined human immunity indicators such as WBC, %Lymph (percentile of Lymphocyte in WBC), %T-cell(percentile of T-lymphocyte in total lymphocyte). CD4, CD8, C3, C4, IgA, IgG, IgM, IgE in peripheral blood to evaluate the health hazard of the TDI-exposed workers. And we examined TDA to evaluate correlation between exposure and effect. Total 90 subjects was selected, 45 workers who worked in the polyurethane-producing factories as an exposed group, and 45 cases who were office workers(10 cases), other blue collors(27 cases), and medical college students(8 cases) as a control group. And the results were as follows; 1. The logarithm of IgE-Log10(IgE)±SD-in peripheral blood of a exposed group was significantly higher than a control group, 2.22 ±0.62 in case group compared with 1.98±0.53 in control group. (p<0.05) 2. IgA and IgM in the polyurethane-producing workers were 261.02±83.12㎎/㎗, 151.97 ±59.64 ㎎/㎗, respectively, and 292.77±100.45, 179.17±100.78 in control group. IgA and IgM was slightly lower in polyurethane-producing group than control.(p>0.05) 3. WBC, %Lymph. %T-cell, C3, C4, CD4, CD8, CD4/CD8 ratio and IgG in case group were 6.391.1 ea/㎖, 37.53 %, 59.54 %, 76.68 ㎎/㎗, 0.76×10(9) ea/L, 0.63×10(9) ea/L, 1.39, and 1606.29 ㎎/㎗, respectively, and 6,974.7 ea/㎖, 35.12 %, 59.64 %, 71.95 ㎎/㎗, 33.94 ㎎/㎗, 0.80×10(9) ea/L, 0.61×10(9) ea/L, 1.39, and 1581.51 ㎎/㎗ in control group. There was no statistical significance between two groups.(p>0.05) 4. In the comparison of each other companies, average of individual urinary TDA in polyurethane paint manufacturing companies is higher than that of polyurethane sponge foaming companies. And, the concentration of 2.6-TDA which is a metabolite of well-vaporized 2.6-TDI is higher than that of 2.4-TDA in the polyurethane sponge foaming companies. But, the concentration of 2.4-TDA which is a metabolite of illvaporized but well skin-absorbed 2.4-TDI is higher in polyurethane paint manufactures. 5. There were no statistical significance in the correlations between individual urinary TDA and immunologic indices.