극단 저체중 신생아에서의 동맥관 개존증 결찰술을 위한 진정맥 마취 경험 2례

최영균,고명진,이상은,조광래,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 仁濟大學校 白病院 2010 仁濟醫學 Vol.31 No.-

Running title: Cases of anesthesia for extremely low birth weight infant. Extremely low birth weight infants (birth weight < 1000 g) are prone to various morbidities such as respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, patent ductus arteriosus, necrotizing enterocolitis and retinopathy. To accomplish successful anesthetic management, many precautions must be continuously taken during the operation. First, inspired oxygen concentration should be adjusted to avoid oxygen toxicity. Second, body temperature must be maintained adequately. Third, hemodynamic parameters should be kept stable. We report 2 cases of successful anesthetic management for extremely low birth weight infant who underwent ligation of patent ductus arteriosus at the neonatal intensive care unit.

Rocuronium의 애별투여방법이 모지내전근의 이완에 미치는 영향

최영균,김승수,이원진,조광래,이상은,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 인제대학교 2009 仁濟醫學 Vol.30 No.-

Objective : There are controversies in pnmmg technique of rocuronium whether it can or can't shorten the onset time. We want to compare the effects of two different priming doses and intervals of rocuronium. Materials and Methods : After giving propofol, 50 patients were randomly assigned to 5 groups. Group I received a placebo, followed 3 min later by rocuronium 0.6 mg/kg. Priming doses and intervals of Group II, Ill, N, V were 0.06 rng/kg and 2 min, 0.12 mg/kg and 2 min, 0.06 rug/kg and 3 min, 0.12 mg/kg and 3 min, respectively. Total dose of rocuronium was 0.6mg/kg. Train of four (TOF) count or ratio and 1st twitch height of TOF (T1) were monitored with 15 secondsintervals. TOF ratio of each groups just before bolus injection, duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were compared. Results : Duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were decreased in priming groups compared to Group 1 (P < 0.01) In group V, significant depression of TOF ratio just before bolus injection was seen (P < 0.05). Conclusion : Priming technique with rocuronium is effective method to shorten the onset of neuromuscular block. But priming dose of rocuronium itself could cause hypoxia and aspiration in awake patients and should be used carefully. Priming dose of rocuronium 0.06 mg/kg and 2 minutes interval maybe relatively safe method.

경막 천자 후 두통 치료 목적의 자가 혈액 봉합술 시행 중 발생한 기뇌증

정순호,김책,김영환,임세훈,이정한,이근무,최영균,김영재,신치만 인제대학교 2006 仁濟醫學 Vol.27 No.-

A 57-year-old woman who was suffered from chronic back pain and radiating pain to left leg visited the local pain clinic. An accidental dural puncture happened at the L4-5 intervertebral space during the procedure with the loss of resistance technique using air. The epidural needle was removed, and a new insertion was done at the L3-4 intervertebral space with administration of the 0.5% lidocaine 8 ml mixed triamcinolone 40 mg. On the next day, she visited again the local pain clinic with complaining of headache. During an epidural autologuous blood patch procedure, she complained of a severe headache, nausea, vomiting, and developed generalized tremor of abrupt onset. There was no evidence of a dural puncture during the procedure. She was referred to our hospital at once. A brain CT scan showed air-filled cavities in basal cistern. She was given conservative treatment during 14 days. After 10 days, follow up brain CT scan showed no air-filled cavity in basal cistern. She was discharged from our hospital without complications.

췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염

이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-

Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.

전신마취 후 발생한 악성고열증 환자의 치료 경험

이근무,정승환,이정한,정순호,최영균,김영재,신치만,박주열,이영민 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Malignant hyperthermia is the disorder of calcium regulation within skeletal muscle associated predominantly with anesthesia. It is triggered by volatile anesthetics and depolarizing neuromuscular blocking agents. We experienced a case of malignant hyperthermia. 50 years old female patient was transferred to our emergency room that she was developed tachyarrhythmia and high fever. She was taken arthroscopic examination under the general anesthesia with enflurane and succinylcholine. We suspected malignant hyperthermia and promptly treated her with dantrolene sodium. She was developed disseminated intravascular coagulopathy and acute renal failure then we were intensive care to her. She was discharged without sequela. We experienced successful management of malignant hyperthermia.

부가중합형 실리콘 인상재의 표면 친수성이 미세부 재현성에 미치는 영향

오영일,황수영,이덕연,김경남,김광만 大韓齒科器材學會 2003 대한치과재료학회지 Vol.30 No.3

The purpose of this study was to investigate the relationship between surface hydrophilicity and detail reproducibility of die stone for hydrophilic polyvinyl siloxane impression materials modified with nonionic surfactants. Hydrophilic polyvinyl siloxane impression materials were prepared with a polydimethylsiloxane composition and nonionic surfactants. The surfactants used were nonylphenoxy poly(ethyleneoxy) ethanol homologs of varying ethyleneoxy chain length. These homologs are designated NP4, NP6, and NPIO according to the mole number of ethyleneoxy group of 4, 6, and 10, respectively. The contact angle, consistency, and detail reproducibility for hydrophilic polyvinyl siloxane impression materials were tested. The incorporation of nonionic surfactant into polyvinyl siloxanes enhanced their hydrophilicity and consequently led to significant reduction in contact angles. Significant differences in contact angle were found among the samples (P < 0.05). The contact angle was lowest when NP4 was incorporated even though NP4 is less hydrophilic than NP6 and P1O. This implies that the exposed surfactant concentration on the surface was highest when NP4 was used. The consistency of surfactant-modified silicone impression materials were not affected by the type of surfactants used in this study. However, NP4-modified polyvinyl siloxane impression material showed the highest quality reproduction of the thinnest line, indicating highest wettability with gypsum among the samples. In conclusion, the surface concentration of surfactant on the silicone impression material was a crucial factor in determining wettability. The suface hydrophilicity of surfactant-modified silicone impression materials was of major relevance to the detail reproduction of die stone.

유한요소법을 이용한 볼트결합 구조부의 조건에 따른 동적변화 해석

鄭泳都,朴世蔓,朴明均 明知大學校 産業技術硏究所 2003 産業技術硏究所論文集 Vol.22 No.-

To join structure together, various methods and processes are available including welding, riveting, bonding with industrial adhesives and fastening by bolts. Analysis of the common areas formed by joining between the structure are significant in that their results can provide critical information for understanding the dynamic behavior of the whole structure. The structural factors affecting the dynamic behavior of the joined structures are usually believed to be materials composing the bolts, bolt sizes and the number of bolts as well as the strength of applied torque and the extent of overlap between the structures joined together. This paper analyzes the impacts of the structural factors such as the bolt sizes, the extent of overlap and the materials composing the structures on the dynamic behavior of the joined structures.

數値模型에 의한 이안지구 帶水層의 傳達係數 推定

鄭만,朴英基 여수대학교 1988 論文集 Vol.2 No.-

The observed data are insufficient to identify the distribution of transmissivities in IAN groundwater reservoir. Therefore, it would be required to transform the observed heads at the piolt points into transmissivities. Therefore, three procedure was tackled for the identification of the spatial distribution of the hydrological parameters; geostatistical estimate of the parameter field on the basis of known well point, heads reconstructed by a numerical model, and modification of the values at pilot points by a minimization algorithm. Using this variogram kriging has been applied to a total of 258 transmissivity value in attempt to quantify their distribution of IAN aquifer. Variogram of the observed and optimized transmissivities at pilot points are adapted to the exponential form. So, it is fitted by theoretical one with coefficients of w=0.623, a=2.743. Values of head obtained through numerical analysis are adjusted to the observation wells. The procedure produced contour map of the estimated transmissivities and the calculated head.

EU통합의 심화와 통상산업정책의 재편

허만,김광수,이갑수,윤영득 서울대학교 국제지역원 1995 국제지역연구 Vol.4 No.1

최근의 세계경제흐름은 세계화와 지여화라는 두 가지 특징적인 양상을 보이고 있다. 오랜 기간 동안 끌어오던 우루과이협상의 타결과 세계무역기구 설립의 합의로 다자간 자유무역주의에 의한 무국경 경제시대가 도래한 반면, 다른 한편에서는 지역통합에 의한 세계시장의 분할이 활발하게 이루어지고 있다. EU는 세계경제의 지역화를 다른 어느 지역보다 더 가속화시키고 있다. EU는 지난 1987에 발효된 유럽단일의정서에 입각하여 1993년에 시장통합을 완성하였고 마스트리히트 조약의 체결로 공동시장의 단계를 넘어 경제동맹으로 진입하여 재정, 금융, 통화정책의 조화를 추구하는 단계로까지 발전하고 있다 따라서 본 연구에서는 EU통합의 심화과정을 살펴보고 그 과정에서 추진되고 있는 통상 및 산업정책으 방향이 어떠할지를 포괄적으로 살펴보는 데 그 목적을 두고 있다. 이러한 목적하에 본 논문에서는 우선 경제통합과는 동전의 양면과 같은 성격을 지니고 있으며 EU의 장기적인 추진목표가 되는 정치적 통합가능성을 그 역사적 발전배경을 통해 살펴보고 있다. 유럽연합의 통합운동은 신기능주의적 진보라고 할 수 있는 장기간의 과정을 거쳐 진행되어 왔고, 재정, 금융 및 통상정책의 통일과 조화에 주안점을 두고 왔으나 이것이 회원국 같은 정치적 협력에도 크게 기여한 것은 사실이다. 특히 마스트리히트 조약을 통한 통화통합 합의로 통합운동이 연방주의적 방향으로 선회하고 있으며 이 방향은 EU의 정치적 통합가능성을 한층 가속화시킬 것으로 전망된다. 통상정책에 있어서는 그 기조가 더욱 자유화의 경향으로 나갈 것인지 아니면 더욱더 보호주의적인 양상을 보일 것이가에 관심이 두어지고 있다. 마스트리히트 조약으로 통상정책결정이 중앙집권적 경향을 띠게 될 것으로 보이지만 EEA조약의 발효로 유럽연합의 무역정책이 더욱 유럽지향적이 되어 역외차별주의가 강화죌 우려가 있다. 따라서 유럽연합의 통상정책 기조는 자유무역을 표방하지만 세계적 차원에서의 무차별 주의 원칙이 이루어지지 못하는 블록지향적 성격은 고수될 것으로 보인다. 유럽연합의 산업정책은 그 일차적 목적을 역내국 사업의 지역네트워크를 강화하여 내생적인 시장의 힘을 자극하기 위해 계속적인 구조조정을 물리적으로 촉발하는데 두고 있다. 그 정책적 접근은 종전의 산업간 구조적 불균형을 보상하기 위한 정부의 보조금지불제도를 폐기하고 상호인정의 원칙과 제도적 조화의 원칙과 보충성의 원칙에 기반을 둔 공동산업정책을 통해 지역, 산업, 기업 간의 경쟁환경을 조성하고 동시에 관련당사자간의 협력을 조장함으로써 세계적 차원에서의 경쟁력을 강화하는 방향으로 나아가고 있다. 유럽의 시장통합은 실질적으로 유럽의 산업과 기업에게 가장 큰 영향을 미치고 있으며 기업에게 기회도 제공하지만 동시에 위협이 되기도 하는 하나의 도전이 되고 있다. 그 영향에는 소속된 산업과 추구하는 전략 및 국제화 정도 등에 따라 차이가 나며, 유형별로는 비교적 규모가 큰 중견기업과 유럽지역에 이미 초국가적으로 활동하느 ㄴ기업들이 가장 큰 영향을 받는 것으로 나타났다. 전체적으로는 기업들이 시장단일화를 통한 경쟁심화에 긍정적인 반응을 보이고 있으며 주로 합리화와 주력사업의 전문화등을 통한 구조재조정과 생산성 향상에의 노력, 기존시장의 확보 및 신시장 개척 그리고 인수·합병 및 전략적 제휴 등을 통한 역내 및 역외간의 협력강화 등을 통해 변화된 시장환경에 보다 적극적이고 능동적인 대응책을 마련하고 있다. There have appeared two characteristics in the recent world economic trend: one is globalization and the other regionalization. With the Urguay Round resolved and the World Trade Organization established, multilateral free trade without national frontiers has come into existence, while a division of the world market by regional integration has also been in full process. The EU seems to more accelerate the regionalization trend of the world economy than any other region. The EU completed market integration in 1993 by the Single European Act. And going beyond the Common Market level, it is entering a new phase seeking harmonization in public finance, monetary and financial policies. Therefore, this paper is to study the process of deepening of the EU's integration and to review what its trade and industrial policies would be like. First, from the above point of view, this paper is to study a possibility of political integration, a long term objective of the EU that is closely connected with the economic integration. The integration movement of the EU, which can be termed as a neofunctionalism, has taken place over the long period of time, focussing on the unification and harmonization in public finance, monetary and financial policies, and trade and industrial policies. As a matter of fact, this process gad considerably increased political cooperation. In particular, due to the currency integration through the Maastricht Treaty, the integration movement gas been directed to the federal approach. This approach is expected to intensify the possibility of the EU's political integration. In regard of trade policy, its study focussed on whether the EU's policy will be directed more toward free trade or protectionism. Trade policy will be more centralized through the Maastricht Treaty, While due to the effectuation of the EEA treaty, it will be gradually more European, thus strengthening probably discriminatory practices toward non-European regions. Therefore the EU's basic trade policy will push forward with free trade on the one hand, but it will tilt to block-oriented tendency on the other hand. EU's industrial policy is based on the principles of reciprocal recognition and of institutional harmonization together with the application of the principle of subsidiarity. It aimes to strengthen competitive power of EU industries at the global level by fostering competition envirnment among regions, industries, and enterprises and by fostering the cooperation among relevant parties. The EU is fucussing its energy on strengthening of industrial regional network of member states and thus restructuring its industries to stimulate the indogeneous power of market. As a matter of fact, the integration of EU's market has made a great contribution to the European industries and its enterprises. The contribution varies according to industry, strategy, and degree of globalization. Looking closely into their typology, medium-sized and big-sized enterprises operating supranationally in Europe are most affected. In general, most of enterprises are positive in the deepening of competion through the integration of markets and are ready to more dynamically develop markets and to prepare acrive countermeasures by seeking new markets and at the same gime by merger and undertakings of enterprises.

변혁적 리더십이 종업원의 업무태도와 역할외 고객서비스에 미치는 영향

정영일,윤만희 대구대학교 경제경영연구소 2012 경제경영연구 Vol.8 No.1

본 연구는 직속상사의 변혁적 리더십에 대한 서비스종업원의 지각이 종업원의 행위적 성과인 역할외 고객서비스와 역할내 업무수행에 미치는 영향을 교환관계 측면에서 검토하는 것이다. 역할외 행동과 관련된 선행연구에 비하여 본 연구는 다음 몇 가지 특성을 지니고 있다. 첫째, 조직의 중요한 성과이며 다른 성과에도 영향을 미치는 서비스종업원의 행위적 성과를 역할외 고객서비스와 역할내 업무수행으로 구분하여 평가하고자 한다. 둘째, 기존 연구와 달리 동일인 평가에 의하여 발생하는 공통방법편의를 최소화하고 보다 객관적인 평가가 되도록 하기 위해서 종업원의 역할외 및 역할내 행동을 직속상사가 직접 평가하도록 하였다. 셋째, 서비스종업원의 역할행동을 교환관계에 따라 설명하기 위해 서비스종업원의 내생적 동기유발에 관련된 역할모호성, 직무만족, 임파워먼트 변수가 변혁적 리더십과 역할외 고객서비스 및 역할내 업무수행과의 관계에 있어 매개적 역할을 수행하는지의 여부를 파악하였다. 제시된 모델과 가설을 평가하기 위해 국내 대기업 계열 생명보험회사의 광역시지역 지점에 근무하는 영업소장(종속변수 평가)과 보험설계사(독립변수와 매개변수 평가)를 대상으로 실증분석을 실시하였다. 본 연구의 제안모델은 만족스러운 자료적합도를 보여주었으며, 제시한 9개 가설 가운데 6개가 통계적으로 유의한 것으로 나타났다. 변혁적 리더십이 종업원의 역할모호성을 감소시키고 임파워먼트를 향상시키는 것을 알 수 있었으며, 특히 매개변수인 임파워먼트가 직무만족에 강한 영향을 미치는 것으로 나타났다. 적어도 본 연구에서는 변혁적 리더십과 직무만족을 제외하고 변혁적 리더십이 내생적 동기유발에 긍정적인 영향을 미치고 있음을 확인할 수 있었다. 그러나 매개변수인 역할모호성, 임파워먼트와 역할외 행동 및 역할내 행동간에는 유의하지 않는 것으로 나타났다. 이는 본 연구가 방법론적 측면에서 보험설계사의 역할행동을 자기평가가 아닌 직속상사가 평가하도록 하였기 때문인 것으로 판단되어진다. The aim of this study is to examine the roles of service employees' perceived leaderships in determining their work attitude and their in-role and extra-role behaviors in the service encounter. behavioral performance, organizational citizenship behavior from the viewpoint of exchange relationships. While there exists a variety of leaderships relevant to customer-contact employees, this paper investigates only immediate supervisors' transformational leaderships for successful implementation of internal marketing. This leadership variable is proposed to affect the mediating variables (role ambiguity, job satisfaction, and empowerment), which in turn influence employee's regular job performance and extra-role behaviors toward customers. The proposed model of this study, which combines perceptions from contact employees (insurance salesman) and their immediate supervisors, shows that the transformational leadership variable contributes directly to role ambiguity, psychological empowerment, and job satisfaction of mediating variables. Also employees' empowerment is found to play a strong mediator role in linking transformational leadership to job satisfaction. As expected, job satisfaction has significant, positive effect on both in-role job performance and extra-role customer services, but, unexpectedly empowerment failed to have a significant effect on in-role performance.