신경섬유종증-제 2형의 진단과 치료 : 16례의 임상경험 Experience of 16 Cases

김정은,백선하,김종수,이상형,오창완,김동규,정희원,김현집,조병규,한대희,최길수 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

Neurofibromatosis type 2(NF-2) is a dominantly inherited disorder characterized by the occurrence of bilateral acoustic neurinomas and the frequent association of other central nervous system tumors. We present a retrospective review of 16 patients with NF-2 who were treated at our hospital from 1984 to 1995 in 13 cases, the diagnoses of Nf-2 were based on the criteria developed at the Consensus Development Conference of National Institute of Health in the United States, and in another 3 cases. the criterias of NF-2 were not fully satisfied, but the diagnoses of NF-2 were highly suspected. The average age of the patients was 27.6 years, ranging from 13 years to 56 years. The most common symptom was hearing difficulty : intervals between symptom onset and deafness ranged from 8 months to 6 years(mean : 2.9 years) One family of NF-2 was documented consisting of a sister a brother and their mother. Nine patients underwent operations on unilateral acoustic neurinomas : these were subtotally removed in eight patients and totally in one patient Among these patients five were deaf on the ipsilateral side at surgery. Among the other four patients with useful hearing before surgery, hearing was preserved to preoperative status in two patients. Four patients with diagnoses of meningioma, received operations to relieve mass effect with subtotal removal in two patients and total removal in the other two. Early diagnosis and treatment are the most important in the management planning of patients with NF-2 for reasons of early manifestation and rapid progression of the disease.

쇄골하정맥을 통하여 중심정맥도관 삽입 실패 후 나타난 혈흉 1예

김대영,김대우,손희원,박상진,이덕희 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Central venous catheterization via an internal jugular vein or subclavian vein has become a common procedure in monitonng CVP and managing severely ill patients. However, there have beennumerous reports of complications associated with central venous catheterization. These include vessel injury, pneumothorax, hemothorax, nerve injury, arrhythmias, artriovenous thrombosis, pulmonary embolism, and infection at the insertion site. We report a case of hemothorax after subclavian vein catheterization failure, along with successful treatment.

질소산화물의 급성 노출로 인한 폐 손상 1례

김정호,김대환,손병철,이창희,김정원,문덕환,이채언,김주인 대한산업의학회 2000 대한직업환경의학회지 Vol.12 No.2

Objectives : Lung injuries due to exposure to nitrogen oxides can occur in various process in industry. We experienced a case of chemical pneumonitis induced by accidental inhalation of nitrogen oxides emitted from the bath in an acid dipping operation. Case : Dyspnea, cough and blood-tinged sputum production, cyanosis, and tachypnea occurred after exposure to oxides of nitrogen. There were bilateral diffuse ground glass opacities in simple chest radiography and high resolutional computed tomography, hypoxemia in arterial blood gas analysis, mixed ventilation defect and reduced diffusion capacity in spirometry. As an oxygen and supportive therapy, after hospitalization, was given, the patient recovered completely from the lung injury on the 8th day after admission. There was no evidence of delayed onset of bronchiolitis obliterance or pulmonary edema in a follow-up for about 6 months. Conclusions : Acid dip operation require more efficient hooding and exhausting system for the prevention of lung injuries caused by inhalation of nitrogen oxides. Also health education for worker need.

직업적 노출에 의한 스티븐스-존슨 증후군에서 트리클로로에틸렌의 노출수준 : 3예의 사례와 문헌고찰을 중심으로

이선웅,김은아,김대성,고동희,강성규,김병규,김민기 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.2

배경: TCE는 심각한 전산적 피부염과 관련 있는 것으로 몇몇 사례들을 통해서 보고되어 왔으나,기존의 사례 보고들에서 노출평가가 수행된 사례는 드물었고 추정되는 노출량 역시 매우 다양하였다. 본 연구에서는 TCE 노출에 의한 것으로 판단되는 스티븐스-존슨 증후군 3예를 확인하고 각 사례들에 대한 작업재연을 통해 노출수준을 추정하였으며,이를 통해 TCE의 직업적 노출수준과 스티븐스-존슨 증후군을 포함하는 전신적 박탈성 피부염 발생의 관계를 이해하고자 하였다. 증례: 사례 1은 24세 필리핀인 여자로 TCE를 이용한 탈지작업을 시작한 35일 후 발진을 포함한 피부증상이 발생하였고 증상이 진행되면서 간기능 이상이 발견되었다. 환자는 스티븐스 존슨 증후군과 독성간염으로 진단되었고 증상발생 39일 간부전으로 사망하였다. 증상발생 전 약물 복용력은 없었고 바이러스 감염 등의 비직업적 원인은 찾을 수 없었으며,작업재연을 통한 TCE의 개인 노출수준 은 TWA 21.9 ppm과 32.3 ppm이었다. 사례 2는 47세 한국인 남자로 TCE를 이용한 탈지 작업을 시작한 20일 후 발진을 포함한 피부증상이 발생하였고 증상이 진행되면서 간기능 이상이 발견되었다. 환자는 중독성 표피괴사증 또는 스티븐스 -존슨 증후군, 전격성간염 및 동반된 패혈증으로 진단되었고 증상발생 42일 간부전 및 패혈증으로 사망하였다. 증상발생 전 약물복용력은 없었고 바이러스 감염 등의 비직업적 원인은 찾을 수 없었으며,작업재연을 통한 TCE의 개인 노출수준은 TWA 30.1 ppm이었으며 세척조 주위의 지역시료는 TWA 116.5 ppm∼229. 7 ppm 이었다. 사례 3은 22세 베트남인 여자로 TCE를 이용한 탐지작업을 시작한 30일 후 발전을 포함한 피부증상이 발생하였고 증상이 진행되면서 간기능 이상이 발견되었다. 환자는 스티븐스-존슨 증후군 및 동반된 독성간염으로 진단되었고 증상발생 37일 증세 호전되어 퇴원하였다. 증상발생전 약물복용력은 없었고 바이러스 감염 등의 비직업적 원인은 찾을 수 없었으며,작업재연을 통한 TCE의 개인 노출수준은 TWA 107.2 ppm이었다. 고찰: TCE에 노출된 일부의 사람들에서 노출 후 2주에서 5주 사이에 심각한 급성 간염이 동반되는 스티븐스­존슨 증후군이 발생할 수 있음을 확인 하였고,이번의 연구결과와 기존의 연구를 종합 할 때 TCE에 대한 감수성이 있는 사람의 상당수는 노출기준 이상의 고 노출에 노 출 후 스티븐스- 존슨 증후군이 발생함을 확인할 수 있었다. 따라서. TCE에 대한 고 노출을 막기 위해 TCE 세척작업에 대한 작업환경 확인과 개선이 우선적으로 필요하며,동시에 노출 후 증상발생기간의 일관성과 노출기준 이하의 저 노출에서의 감작 가능성을 배제할 수 없음을 고려하여,작업시작 후 1개월경의 특수건강검진 역시 고려되어야 할 것으로 판단된다. Back ground: Trichloroethylene (TCE) has been reported to be related to severe generalized exfoliative dermatitis frequently accompanied by toxic hepatitis. The measurements of environmental exposure were limited in the previous case reports and the reported exposure values were also diverse. We reviewed three cases of Stevens-Johnson syndrome associated with TCE. The work environment was measured by the Korea Occupational Safety and Health Agency (KOSHA) after the cases occurred. From the study results, we intended to clarify the relationship between TCE exposure level and Stevens-Johnson syndrome. Case report: Case 1. A 24-year-o1d Filipino female worker developed a skin rash 35 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. She died of hepatic failure 39 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 22.0 to 32.3 ppm (Personal exposure level) with TWA. Case 2. A 47-year-o1d Korean male worker developed a skin rash, 20 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. He was diagnosed with Stevens-Johnson syndrome, toxic hepatitis and sepsis. He died of hepatic failure and sepsis 42 days after the onset ofthe first symptom. He had no previous history of taking medicine or viral infection. The work environment measured 30.1 ppm (Personal exposure level) and 116.5∼229.7 ppm (area exposure level close to the degreasing rnachine) with TWA. Case 3. A 22-year-old Vietnamese female worker developed a skin rash 30 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. Her symptoms improved and she was discharged 37 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 107.2 ppm (Personal exposure level) with TWA. Discussion: These three case reports and the previously reported cases indicated that the majority of people susceptible to TCE develops Stevens-Johnson syndrome after high-level TCE exposure (above the TWA occupational exposure limit of 50 ppm). Therefore, work environmental survey and improvements to the TCE degreasing process are essential to prevent high exposure. Furthermore, considering the consistency of the latency period in symptoms and the possibility of sensitization in low-level exposure, we recommend that the first specific health examination also should be conducted 1 month after workers have commenced working.

페놀분해 효모 Candida tropicalis PW-51의 분리 및 분해특성

김성빈,김치경,김희식,이창호,신기선,권시석,윤병대,오희목 한국미생물생명공학회 ( 구 한국산업미생물학회 ) 1996 한국미생물·생명공학회지 Vol.24 No.6

본 연구는 페놀과 포름알데히드를 포함하는 페놀계수지 산업폐수의 생물학적 처리에 이용할 목적으로 포름알데히드의 존재하에서 페놀분해능이 우수한 효모를 sludge로부터 분리하여, 형태적 및 생리 생화학적 특징을 조사하여 Candida tropicalis PW-51로 동정하였다. 회분식 배양에서 C. tropicalis PW-51의 페놀 분해한계는 2,000 mg/ℓ이며, 58시간내에 완전히 분해하였다. C. tropicalis PW-51은 초기접종량이 9×10 exp (6) cells/㎖, 배양온도는 30℃, pH는 7.0에서 페놀 분해효율이 높았으며, 500~2,000 mg/ℓ의 페놀농도에서 조사된 페놀에 대한 평균 분해율은 페놀 1,000 mg/ℓ에서 45.5 mg/ℓ/h 가장 높았다. C. tropicalis PW-51의 페놀분해시 catechol 1,2-dioxygenase의 활성이 크게증가하므로 ortho-path-way에 의해 페놀을 분해하는 것으로 판단되었다. 따라서, C. tropicalis PW-51는 페놀계 수지 산업폐수의 생물학적 처리에 효과적으로 이용될 수 있는 균주로 사료된다. For the biological treatment of phenolic resin wastewater containing phenol and formaldehyde, a phenol-degrading yeast was isolated from the papermill sludge, and then identified as Candida tropicalis PW-51 according to morphological, physiological and biochemical properties. The strain was able to degrade high phenol concentrations up to 2,000 mg/ℓ within 58 hours in batch cultures. Phenol-degrading efficiency by the strain was maximum at the culture conditions of a final concentration of 9×10 exp (6) cells/㎖ 30℃ and pH 7.0. The mean degradation rate of phenol was highest at 45.5 mg/ℓ/h in 1,000 mg/ℓ phenol from 500 mg/ℓ to 2,000 mg/ℓ phenol. Because the enzyme activity of catechol 1,2-dioxygenase increased in the course of degradation of phenol, it seems that this strain degrades phenol via the ortho-cleavage of benzene ring. The isolate C. tropicalis PW-51 could be effectively used for the biological treatment of phenolic resin wastewater.

[논문]Operational Characteristics of CO2 Laser Adopted by Superposing-Discharge

Hee-Je Kim,Hyun-Ju Chung,Byoung-Dae Min,Jong-Han Joung,Sung- lun Park 釜山大學校生産技術硏究所 2003 生産技術硏究所論文集 Vol.62 No.-

오늘날 현저한 CO2 레이저의 응용 추세에 발맞추어 보다 다양한 형태의 출력 제어 기술이 대두되고 있다. 본연구에서는multi-Pulse Superposing-Discharge 기술을 이용하여 다양한형태의 CO2 레이저의 펄스를 성형 하였다. 펄스 성형을 위한 방법으로 PIC one-chip microprocessor를 이용하여 삼중 PFN 모률의 SCR을 각각 고유의 지연시간을 가지도록 제어하였다. 실험에 사용된 삼중 PFN 모률의 전원 회로는 각각 캐패시터 인덕터,SCR,고압 펄스 트랜스 그리고 고압 트랜스 2차측에 브릿지 정류기로 구성 하였다. 고압 펼스 트랜스의 1차측을 제어하므로서 PFN 모률의 동작을 저 전압에서 수행 할 수 있다. 트랜스의 2차측에 연결된 전파 정류기는 펄스 에너지를 부하에 지속적으로 전달한다. 본 연구에서는 삼중 PFN 모률의 각각의 SCR을 다른 시간 가격을 두고 트리거 하므로서 다양한 Long pulse shaping을 실현하였다. 또한 약 250-1000μs 의 주기를 가지는 다양한 펄스형 레이저 빔을 얻었다.

만성 승모판 패쇄부전증 환자에서의 안지오텐신 전환효소 억제제의 장기 투여 효과

김대희,이명묵,이해영,조현재,박승정,서재빈,서정원,양한모,윤창환,조상호,이준희,김용진,김명아,손대원,오병희,박영배 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.2

급성심근경색후 발생한 심실중격결손 2례

김태희,이재호,김애란,허민영,문치숙,정수룡,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Ventricular septal defect remains an infrequent but devastating complication of acute MI. Approximately 1∼3% of cases of acute myocardial infarction are complicated by ventricular septal rupture in the prethrombolytic era and the incidence has decreased to 0.2% with reperfusion therapy. This mechanical complication usually occurs within the first 10 to 14 days when necrotic tissue is most abundant and the collateral coronary circulation is not well developed. This lesion is generally associated with complete coronary obstruction rather than severe stenosis. Rupture of the ventricular septum is a severe mechanical complication of acute myocardial infarction, usually resulting in death unless surgical repair is performed. The bad prognosis of this event within the first 2 weeks indicates the need for early surgical rapair. This complication is more frequent after the first acute myocardial infarction in the elderly and secondary to a transmural myocardial infarction. We report two cases of ventricular septal rupture after acute myocardial infarction.

측뇌실내 종괴의 감별진단 및 수술적 치료

김동규,김봉수,이상형,심기범,왕규창,정희원,김현집,조병규,최길수,한대희 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.2

We present a series of 42 patients with the lateral ventricular mass lesions who underwent operative removal between 1979 and 1992 at the Seoul National University Hospital. These lesions included 29 tumors, 10 benign cysts and 3 arteriovenous malformations. There were 20 lesions in the trigone, 14 in the frontal horn, 6 in the body, and 2 in the temporal horn. Together with the age of the patient, the location in the lateral ventricle and the CT or MR patterns, the range of the differential diagnosis of the lesions can be narrowed. The mass were removed by various surgical approaches ; 11 by the middle frontal gyrus, 10 by the superior parieto-occipital, 13 by the middle temporal gyrus, 4 by the anterior transcallosal, 2 by the posterior transcallosal and 3 by the combined approaches. The superior parieto-occipital approach left postoperative morbidities in 64% and other approaches in 20 to 25% of the cases. These morbidities included hemiparesis, hemianopsia, aphasia, memory distubance and seizure. Most hydrocephalus disappeared without the shunting procedure after removal of the lateral ventricular mass. The high frequency of postoperative complications in the superior parieto-occpital approach require meticulous consideration in the selection of this approach.

소규모사업장 용접근로자들의 소음·용접흄·망간 노출에 관한 연구

김동구,문덕환,이채관,박명희,함성애,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : This study was conducted for the purpose of investigating the level exposure of welders to noise, welding fume and Manganese(Mn) related to this process. Methods and Material : All subjects in this study were welders engaged in CO2 arc and coated arc welding process especially in small-scale enterprises classified by type of manufacture of ship building, repairing and of other fabricated metal products, which is located in Gimhae and Milyang of Kyeongsang province in south Korea. Air sampling of welding fume was measured, shipped and analyzed on the basis of national institute for occupational safety and health(NIOSH) method in U.S. and work environment measurement method established in south Korea. To measure Noise in the work environment, Noise dosimeter was used on the basis of work environment measurement method established in south Korea. Result : This study was performed during a period from January, 2000 to December, 2001 and Results were as follows: 1. Noise level measured in this work environment was higher than national criteria for permissible exposure limit on health examinations related to hearing loss. 2. The concentration of welding fume and Mn in manufacture of ship building and repairing was higher than those in manufacture of other fabricated metal products. 3. In conditions of existing in ventilation system installed and operated, the concentration of welding fume and Mn was slightly lower than those of not existing. 4. In conditions of existing in sufficient air supply from out door into the work place relied on natural exhaust system, the concentration of welding fume and Mn was slightly lower than those of in not sufficient. 5. In all subjects, a rate of wearing ear plug and respiratory mask for dust and fume was lower than that of not wearing. Conclusion : According to above results, this study suggests that more positive work environment managements such as the use of portable local ventilation system, the supply of highly qualified personal protective equipment, and consecutive education and training related to health protection should be need to acquire suitable health protection program for welders engaged in small-scale enterprises in Korea.