특발성 경화성외안근염 환자에서 발생한 눈꺼풀의 IgG4 연관경화병증 1예

윤제환,정지웅,지미정,Je Hwan Yoon,Jee Woong Jung,Mi Jung Chi 대한안과학회 2013 대한안과학회지 Vol.54 No.1

Purpose: To report a case of IgG4-related sclerosing disease involving the eyelid in an idiopathic sclerosing myositis patient. Case summary: A 51-year-old woman presented with swelling, redness, and tenderness of the left lower eyelid of 1 month duration had taken an immunosuppressant for idiopathic sclerosing myositis. Eye movements showed limitation all directions but there was no exophthalmos. A palpable mass was noted in the left lower eyelid. The left extraocular muscles were hypertrophied but the lacrimal gland was normal on orbital magnetic resonance imaging. IgG4-related sclerosing disease was confirmed by immunostained biopsy from the left lower eyelid, showing infiltration of IgG4-positive lymphoplasmacytic cells. The patient was given oral steroids and an immunosuppressant and the symptoms did not recur for at least 7 months. Conclusions: IgG4-related sclerosing disease involving ocular adnexa usually consists of bilateral lacrimal gland involvement. Additionally, the orbital soft tissue involvement without dacryoadenitis is rare. The authors of the present study report a case of IgG4-related sclerosing disease involving the left lower eyelid in an idiopathic sclerosing myositis patient and should be considered in the differential diagnosis of eyelid masses.

눈꺼풀처짐을 동반한 위눈꺼풀올림근에 국한된 외안근염 1예

윤제환,문현승,지미정,Je Hwan Yoon,Hyun Seung Moon,Mijung Chi 대한안과학회 2012 대한안과학회지 Vol.53 No.5

Purpose: To present a rare case of idiopathic orbital myositis involving levator palpebrae superioris. Case summary: A 27-year-old male presented with a 1-week history of redness, discomfort, swelling, and drooping of his left upper eyelid. A computed tomography scan showed isolated enlargement of the right superior rectus/levator muscle complex. On examination, there was a left blepharoptosis, although eye movements were normal. The authors treated the patient with 3rd-generation cephalosporin; however, after 3 days, the symptoms did not improve. Subsequently, the patient was diagnosed with idiopathic orbital myositis and treated with oral corticosteroids for 1 month; the symptoms gradually resolved. Conclusions: Idiopathic orbital myositis is a subtype of nonspecific orbital inflammation primarily involving the extraocular muscles. Although the exact cause of orbital myositis is unknown, an immune-mediated pathophysiologic mechanism appears to be one of the causes. Medial rectus myositis is the most common, and isolated levator muscle myositis is very rare. The authors of the present study reported a case of orbital myositis involving the levator palpebrae superioris which should be considered a differential diagnosis of blepharoptosis with eyelid swelling. J Korean Ophthalmol Soc 2012;53(5):707-711

안검에 발생한 호산구 증가증을 동반한 혈관림프증식증 1예

윤제환,지미정,Je Hwan Yoon,Mijung Chi 대한안과학회 2012 대한안과학회지 Vol.53 No.5

Purpose: The authors of the present study describe a rare case of angiolymphoid hyperplasia with eosinophilia (ALHE) of the eyelid. Case summary: A 63-year-old male who was diagnosed with ALHE based on biopsy of an inguinal mass presented with an eyelid mass of 1 month duration. A light brown, solitary, 1.0 × 0.5 cm-sized mass involved the right upper eyelid. There was no lymphadenopathy, but eosinophilia was present. An excisional biopsy of the mass was performed for diagnosis and management. Macroscopic examination of the excised mass revealed a well-defined, smooth, firm, yellowish-red colored lesion measuring 1.0 × 0.6 × 0.5 cm. Histopathology showed the proliferation of small blood vessels, many of which were lined by enlarged endothelial cells with uniform ovoid nuclei and intracytoplasmic vacuoles. The distinctive endothelial cells were described as having a cobblestone appearance. In addition, a perivascular and interstitial infiltrate composed primarily of lymphocytes and eosinophils was present. ALHE was finally confirmed with clinical and microscopic examination. Conclusions: The authors of the present study report a rare case of ALHE of the eyelid and suggest that a differential diagnosis should be considered. J Korean Ophthalmol Soc 2012;53(5):712-715

열공망막박리 환자의 수술 후 시야 및 망막신경섬유층 변화 비교

윤제환,남동흔,이대영,Je Hwan Yoon,Dong Heun Nam,Dae Young Lee 대한안과학회 2012 대한안과학회지 Vol.53 No.9

Purpose: To compare the visual field and retinal nerve fiber layer of scleral buckling (SB) and primary pars plana vitrectomy (PPV) for treatment of simple rhegmatogenous retinal detachment (RRD). Methods: We studied 20 eyes with RRD that were underwent successful surgical reattachment. Visual field test and retinal nerve fiber layer (RNFL) thickness measurements were performed in patients, and outcomes were compared not only between the operated eye and fellow eye, but also between SB and PPV 3 months postoperatively. Results: After the operation, PSD and MD were higher in the operated eye than in the fellow eye (p = 0.002, p < 0.001, respectively). RNFL thickness was lower in the operated eye than in the fellow eye (p < 0.001). No significant differences in BCVA were detected between SB and PPV. However, the respective differences between the operated eye and fellow eye regarding pattern standard deviation (4.0 ± 4.0, 0.7 ± 1.5), mean deviation (6.5 ± 4.6, 1.9 ± 1.9), and RNFL (8.2 ± 10.3 μm, 1.8 ± 2.7 μm) were significantly higher in PPV than in SB. Conclusions: Both visual field defect and retinal nerve fiber damage are significantly larger in PPV than in SB. J Korean Ophthalmol Soc 2012;53(9):1285-1290

세균각막염 원인균주의 항생제 감수성과 초기 항생제 선택의 적절성

윤제환,정지웅,문현승,문호석,신경환,김균형,Je Hwan Yoon,Jee Woong Jung,Hyun Seung Moon,Ho Seok Moon,Kyung Hwan Shyn,Kyun Hyung Kim 대한안과학회 2013 대한안과학회지 Vol.54 No.1

Purpose: The present study aims to determine the common pathogens involved in the etiology of bacterial keratitis and to analyze not only the antibiotic susceptibility of bacterial isolates from patients with bacterial keratitis but also the propriety of initial treatment. Methods: A retrospective study of 161 eyes in 161 patients with bacterial keratitis, who were diagnosed by cultures from 2000 to 2011, was performed. Causative bacteria and antibiotic susceptibility were evaluated in consecutive 6-year periods. Results: The most common bacteria was the pseudomonas species in the 2 time periods tested and cefazolin with tobramycin was the most commonly used antibiotic (125 cases, 77.6%) for initial treatment of bacterial keratitis. In vitro testing showed gram-negative susceptibility to tobramycin and ciprofloxacin was over 70%, gram-positive susceptibility to cephalothin and vancomycin was 100% and there was no significant difference between the 2 time periods tested. Eight cases had resistance to the initial treatment, but only 1 case showed treatment failure. Conclusions: Antibiotics used for initial treatment of bacterial keratitis were able to obtain a proper effect but several cases showed bacterial resistance to antibiotics. Thus, continued testing is essential to monitor for antibiotic resistance.

해군장병의 마이봄선기능장애가 건성안에 미치는 영향

윤제환 ( Je Hwan Yoon ) 국군의무사령부 2014 대한군진의학학술지 Vol.45 No.1

Objectives: We conducted a study to evaluate influence of meibomian gland dysfunction of ROK navy soldiers on symptoms and signs of dry eye syndrome. Methods: We selected the 50 male soldiers on service with dry eye syndrome who visited in the department of ophthalomology, korea naval 3rd fleet and the other 50 male soldiers who visited for routine physical exams from April, 2014 to July, 2014. We checked tearfilm break up time(TBUT), fluoescein staining, ocular surface disease index(OSDI) and meibomian gland dysfunction grade. Then we compared between patient group and comparison group and we performed correlation analysis for each group. Results: The OSDI and meibomian gland dysfunction grade were significantly higher(p<0.05) and TBUT was significantly shorter(p<0.05) in the patient group than the comparison group. The OSDI was correlated with TBUT and meibomian gland dysfunction grade in the patient group but it was not correlated with them in the comparison group. Conclusions: Meibomian gland dysfunction is associated with symptom and sign of dry eye syndrome and its severity is also related to severity of dry eye syndrome.

음주에 따른 음성 변화에 대한 고찰

김정현,윤제환,조형호,조연,조재식,Kim, Jung-Hyun,Yoon, Je-Hwan,Cho, Hyung-Ho,Cho, Yeon,Cho, Jae-Sik 대한후두음성언어의학회 2002 대한후두음성언어의학회지 Vol.13 No.1

Background and Objectives : It has been pointed out that alcohol intake in human beings induces changes in voice register and maximum phonation time. These changes supposedly result from injection of the vibratory vocal folds. The purpose of this study was to clarify the voice changes associated with alcohol intake and the changes of laryngeal mucosa. Materials and Methods : The subjects included 29 volunteers, including 20 men and 9 women ranging in age from 22 to 31 years. Alcohol intake was accomplished by oral administration of 23% soju 1 bottle (255cc). Serum alcohol concentration levels were evaluated hourly for 3 h after ingestion of alcohol. Seven measurements were performed at pre-alcohol intake and post-alcohol intake hourly : fundamental frequency, jitter, shimmer, noise to harmonic ratio as the acoustic analysis, maximal phonation time, mean flow rate, and subglottal pressure as the aerodynamic analysis. The changes of laryngeal mucosa were evaluated by flexible laryngoscope at each measurement. Results : By comparing the acoustic and aerodynamic data and laryngeal mucosa before and after alcohol intake, there were not remarkable changes (p>0.05). Conclusion : The voice and laryngeal mucosa have not remarkably changed according to alcohol concentration in this study. Furthermore studies on the voice change induced by multiple alcohol concentrations are required.

비내시경을 이용하여 제거한 Thornwaldt낭 1예

조재식,김정현,윤제환,문석진 대한이비인후과학회 2002 대한이비인후과학회지 두경부외과학 Vol.45 No.7

Thornwaldts cyst is a rare benign developmental lesion induced by persistent notocord remnants within the midline nasop-harynx. Although most patients with the cyst are symptom-free, inflamation or an absces can develop. Treatment involves rette, scissors, and so on. But recently by introduction of nasal endoscopy and its extended application, transnasal approach using nasal endoscopy becomes useful surgical approach to nasopharynx. We report a case of Thornwaldts cyst which was successfuly removed with nasal endoscopy in a 30-year-old man. (Korean J Otolaryngol 2002;45:722-4)

중소기업 경영환경이 스마트공장 수준에 미치는 영향

김현득,이경근,윤제환,염세경 대한경영학회 2019 大韓經營學會誌 Vol.32 No.9

A smart factory is emerging as the most obvious countermeasure against the manpower shortage and the increase of customer demand which the manufacturing industry is experiencing all over the world. In the case of Korea, it is inferior in terms of technology and quality competitiveness to the US, Germany and Japan, which are traditional manufacturing powers and price competitiveness to China, which has been growing fast due to its labor intensiveness. In addition, There is also a negative outlook that Korea will drop from the 5th to 6th place in the ranking of the global manufacturing countries by 2020. Manufacturing proportion is close to 30%, SMEs account for more than 99% of all industries in Korea. For SMEs, Korea has established national standards(KS : Korean Industrial Standards) for the spread of smart factory in 2016 and is actively supporting the development of 30,000 smart factories by 2022 based on the best ICT competitiveness(World No.1 in 2017-2018) This study was conducted to provide practical assistance to SMEs, which have difficulty in developing their own smart factories due to poor available resources and insufficient systems· processes compared with large enterprises. For this study, 67 SMEs were assessed at the smart factory level by applying diagnostic model developed in accordance with manufacturing characteristics. We conducted statistical and qualitative analysis by classifying the data into various business conditions (industry type, production method, delivery to large company, sales amounts, etc.) of the company. In addition, we have presented priority tasks to improve the smart factory level by supplementing the weakness shown in the diagnosis result. As a result of the diagnosis, the overall smart factory level was 19%, the operational division 29% and the hardware/software division 8%. Diagnostic scores to classify into main five industries are 17∼21%, which is “Beginner” of the 5 steps of smart factory. While the levels of operational division were at 27∼31%, H/W·S/W were at only 5∼13%. The level of H/W·S/W in comparison with operational division is so low that ungent and sufficient support seem to be necessary. In operational division, Factory Field Basic, R&D Business, Production Control, Quality Control and Reference Information Standardization were excellent, Strategy, Facility Automation and Facility Management were weak. The correlations of R&D Business-Quality Control(r(correlation coefficient)= 0.639) and Production Control-Quality Control(r= 0.683) between diagnostic categories were the highest. This shows that when the R&D quality is high, the level of manufacturing quality control increases, the repetitive production control and quality monitoring activity have the same tendency. There were almost no significant differences in the results of diagnosis by the type of industry, production method and delivery to large company but significant differences regarding Pre-built IT system, number of employees, sales amounts and number of smart factory support. We found that the existing infrastructure and size of the company are important for building of smart factory. The smaller the size of a company, the more likely it is that H/W·S/W needs to be built after PI(Process Innovation) activities are prioritized to increase operation efficiency. The same is true of large company. “Facility Automation” was the worst of all categories in the operational division, so all companies seemed to be more interested in H/W and facility ICT applications. 65% of the priority tasks were the PI project for the improvement of the company structure. Through this study, we proposed benchmarking opportunities to the industry by presenting smart factory level assessment and analysis results according to SMEs business conditions. Finally, the limitations of this study and the direction of future research were discussed. 전 세계적으로 제조업이 겪고 있는 인력난, 고객요구 증대 등에 대한 대응방안으로 스마트공장이 떠오르고있다. 우리나라의 경우 전통적 제조강국인 미국·독일·일본에는 기술·품질경쟁력 측면에서, 노동집약으로 고속성장을 일궈온 중국에는 가격경쟁력 측면에서 밀리고 있다. 본 연구는 대기업에 비해 열악한 가용자원과 미흡한 시스템·프로세스로 자체적인 스마트공장 추진이 어려운중소기업에 실질적인 도움을 주고자 진행되었다. 제조업의 스마트화를 위해 제조 업무특성에 맞추어 개발된진단모델을 적용하여 67개 중소기업의 스마트공장 수준을 평가하였다. 평가결과에 대해 기업의 다양한 경영환경(업종, 생산방식, 대기업납품여부, 매출액 등)에 따라 분류하여 통계·정성적 분석을 실시하였다. 또한 진단결과에서 나타난 취약점을 보완하여 스마트공장 수준을 제고할 수 있도록 우선 추진과제를 제시하였다. 진단결과 전반적인 스마트공장 수준은 19%이며 운영부문이 29%, H/W·S/W부문이 8%으로 나타났다. 주요업종별(금속제조, 전기전자, 고무/플라스틱, 화학물질, 비금속광물) 진단점수는 17∼21%로 스마트공장 구축정도를 5단계로 봤을 때(시작, 준비, 진행, 완성, 고도화) 모두 시작단계이며 운영부문은 27∼31%로 준비 초기수준이라 볼 수 있으나 H/W·S/W부문은 5∼13%로 시작 초기단계 수준이었다. 운영부문은 공장현장기본, R&D업무, 생산관리, 품질관리, 기준정보 표준화가 우수하였고 스마트공장 전략과 설비자동화, 설비관리가 미흡하였다. 기업 경영환경에 따라 다양한 측면에서 분석하였는데 업종별, 생산방식별, 대기업 납품여부에 따른 유의차는 미약했으나 IT 솔루션 보유여부, 종업원수, 매출액, 스마트공장 지원사업 횟수에 대해서는 유의차가 존재하였다. 특히 전체 운영부문 중에 “설비 자동화”가 제일 부족하기에 H/W 및 설비 ICT 구축에 좀 더 관심을가져야 할 것으로 보였다. 스마트공장 구축에 있어 기존 인프라와 기업규모가 중요함을 알 수 있었고 PI 활동을선행해 운영 효율성을 높인 뒤 H/W·S/W를 도입해야 할 것으로 판단되었다. 본 연구를 통해 중소기업 경영환경에 따른 스마트공장 수준평가 및 결과분석 사례를 제시하여 산업계에벤치마킹의 기회를 제시코자 하였다. 마지막으로, 본 연구의 한계점 및 향후 연구방향이 논의되었다.

진주종성 만성 중이염에 합병된 경뇌막외 농양과 횡정맥동혈전염

문태옥,민경민,윤제환,장인원 대한이비인후과학회 2001 대한이비인후과학회지 두경부외과학 Vol.44 No.1