부산·울산·경남지역 직업병 감시체계

김정일,김병권,김정원,채창호,이철호,강동묵,김지홍,김진하,김영욱,이영하,이지호,김정호,윤형렬,유철인,정백근,장태원,김운규,윤동영,강진욱,김종은,안진홍,이동준,장준호,이광영,송혜란,최영희,이용환,조병만,최홍렬,고상백,김은아,이유진,홍영습,정갑열,김정만,김준연 大韓産業醫學會 2004 대한직업환경의학회지 Vol.16 No.1

Objective: Occupational medicine specialists in the Busan, Ulsan and Kyung-Nam areas established an area-based occupational disease surveillance system and used this system to collected case information for the purpose of preventing occupational diseases Methods: l l hospital participated in this system. The authors selected five main diseases, which were hand-arm vibration syndrome (HAVS), work-related musculoskeletal disorder (WRMSD), occupational asthma, occupational skin disease and occupational and occupational lung cancer and established their case definitions. All cases were reported on the web, and real time analysis was conducted. Results: Between April 2001 and April 2003, 192 cases of HAVS, 118 cases of WRMSD, 33 cases of occupational asthma, 17 cases of occupational skin disease and 17 cases of occupational lung cancer (for a total of 377 cases of these five main diseases) were reported. most of the HAVS cases came from shipbuilding, and 172 of them (92.7%) were associated with grinding. Of the four main types of WRMSD, carpal tunnel syndrome (CTS) was the most prevalent with 46 cases and shipbuilding was also the main industry involved (83.9%). The ergonomic risk factors involved mainly associated with the hand. In 19 (57.6%) and 4 (12.1%) cases of occupational asthma, the agents involved. The causative agents of occupational lung cancer included Cr, welding fume, PAH, Ni, etc. 10(58.8%) of the cases were diagnosed as squamous cell carcinoma and 5(29.4%) as adenoma. Conclusion: This result showed that an area-based occupational disease surveillance system might provide an effective method of evaluating the prevalence of such diseases, however the Busan, Ulsan and Kyung-Nam provinces are too large to be treated as individual areas. Therefore, the authors suggest that each province should establish its own surveillance system.

경도인지장애 환자에서 복합-일상활동의 제한

홍지혜,정한용,김양래,이소영,김진만 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.4

Objectives : Mild cognitive impairment (MCI) is distinguished from mild dementia by an absence of global intellectual deterioration and the preservation of activities of daily living (ADL). Recently, however, it became apparent that impairment of instrumental activities of daily living (IADL) is present before the threshold of dementia is reached. Thus, we want to examine whether IADL are impaired in patients with MCI, and which items of IADL are particularly involved. We divided the MCI group into amnestic (aMCI) and non-amnestic MCI (naMCI), and compared to the cognitively nonnal controls. In this study, we focused on the instrumental activities of daily living (IADL). Methods : The sample consisted of 69 community-dwelling older adults from a welfare center for the aged in Korea. The subjects were divided into three diagnostic groups; aMCI [N=19, memory domains below -1.5 standard deviation (SD)], naMCI (N= 19, other cognitive domains below -1.5 SD, except memory domains) and cognitive normal controls (N=31). Subjects were assessed both on IADL and the cognitive function. In order to assess the IADL, we used the Seoul -Instrumental Activities of Daily Living (S-IADL). Included measures of cognitive tests are as follows ; Seoul Verbal Learning Test (SVLT), Rey Complex Figure Test (RCFT), Korean-Boston Naming Test (K-BNT), Stroop test, and Korean-Mini Mental Status Examination (K-MMSE). Groups were compared on the S-IADL and the cognitive tests. Results : The three groups did not differ in the mean age, gender distribution and years of education. S-IADL were shown to be different between the groups in this study. Suects with aMCI were significantly more impaired in S-IADL in comparison to the controls [F (2,50) = 4.251, P=0.020]. And on four items ofS-IADL (shopping, transportation, medication and talking about recent events), subjects with aMCI showed higher impairment compared to the controls. However, the S-IADL did not differ between the subjects with naMCI and controls. Conclusion : In this study, impairment of S-IADL was shown in subjects with aMCI. And S-IADL ofnaMCI was not Significantly differed from aMCI and controls. The results suggest that naMCI would be distinguished from aMCI in characteristics and prognosis.

Case Report : Hepatoid Carcinoma of the Pancreas Combined with Neuroendocrine Carcinoma

( Ji Ye Jung ),( Yoon Jae Kim ),( Hee Man Kim ),( Hong Jeoung Kim ),( Seung Woo Park ),( Si Young Song ),( Jae Bock Chung ),( Chang Moo Kang ),( Joo Yeon Pyo ),( Woo Ick Yang ),( Seung Min Bang ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.1

Hepatoid carcinoma is a primary extrahepatic carcinoma whose morphology, immunohistochemistry, and behavior are similar to those of hepatocellular carcinoma. The most common sites of extrahepatic carcinoma are the stomach and ovary, but nine cases of hepatocellular differentiation of the pancreas have been reported in the literature. We report another case of hepatoid carcinoma of the pancreas that was associated with the development of a pancreatic endocrine carcinoma in a 46-year-old man. Serum alpha-fetoprotein (AFP) was elevated to 262.49 IU/mL and radiological examinations revealed a mass measuring 7.5 cm in diameter in the head of the pancreas. He underwent a conventional Whipple operation, and light microscopy showed adenocarcinoma that was immunopositive for AFP, hepatocyte antigen, cytokeratin, chromogranin, synaptophysin, and alpha-1 antichymotrypsin. Although hepatoid differentiation was not shown unequivocally histologically, other immunohistochemistry findings supported the diagnosis of hepatoid carcinoma combined with neuroendocrine carcinoma. The patient was healthy and had no evidence of recurrence at 4 months after the surgery. This report describes why hepatoid carcinoma should be considered as a differential diagnosis of a pancreatic mass, especially when serum AFP is elevated. (Gut Liver 2010;4:98-102)

수종의 섬유보강재가 복합레진의 파절강도에 미치는 영향

박지만,조용범,홍찬의 대한치과보존학회 2000 Restorative Dentistry & Endodontics Vol.25 No.3

The effect of fiber reinforcing materials on the fracture strength of composite resin was evaluated. Each ten composite resin bars reinforced by glassfiber [Fiber-Splint MLR(polydentia SA. Switzerland)], polyethylene fiber [Ribbond R Ribbond Inc., U.S.A)] and polyaramid fiber [Kevlar R(DuPont U.S.A.)]were loaded under the 3-point compression technique. Another ten pure composite resin bars without reinforcement were used as a control group. Then mean fracture strength and standard deviation were calculated and a ANOVA and Scheffe test were used in statistics. The results were as follows: 1.Kevlar group showed the highest fracture strength as 175.5MPa (p〈0.05). Fiber-splint ML group showed the lowest fracture strength as 112.7MPa. 2.The mean value of fracture strength in Ribbond group was 136.4MPa, and that of ulcerated control group was 143.6MPa. No difference was found between the two groups. 3.Ribbond and Kevlar reinforcement groups showed a catastrophic failure, where complete separation of pieces occurs to a unaspirated fracture pattern. The use of Kevlar reinforcement fibers with composite resin showed significant increase in the average load failure and the presence of the fibers did prevent the catastrophic crack propagation present in the unreinforced samples. The use of Ribbond reinforcement fibers with composite resin showed no significant increase in the average load failure. However, the presence of the fibers did prevent the catastrophic crack propagation. Because high strength of glassfiber are rapidly degraded on exposure to moisture and humidity. The use of Fiber-splint ML reinforcement fibers with composite resin showed significant decrease in the average load failure and displayed catastrophic fractures.

전자 서베잉을 이용한 서베이드 금관과 국소의치 프레임워크 디자인

홍용신,박은진,김성균,곽재영,허성주,박지만 大韓齒科保存學會 2011 Restorative Dentistry & Endodontics Vol.36 No.6

구강 스캐너와 CAD/CAM 기술로 인해 컴퓨터로 제작하는 방식이 활발히 보급된 고정식 보철 증례와는 달리, 의치를 디지털 방식으로 제작하는 데에는 아직 한계가 많다. 촉각을 느낄 수 있는 입력 장비와 전자 서베잉의 개념, 그리고 쾌속 조형법의 적용으로 인해 국소의치를 디지털로 제작할 수 있는 솔루션이 최근 소개되고 있다. 본 증례보고에서는 이러한 국소의치의 디지털 솔루션을 이용하여 총 다섯 명의 환자에서 서베이드 금관 및 국소의치를 제작하였다. 인상 과정상의 문제로 모형과 실제 치아 사이의 형태적 차이가 있었던 경우를 제외하고는 국소의치의 적합도는 우수했으며, 장착 후 안정성과 착탈 시의 유지력 또한 임상에서 적용하는 데에 문제가 없었다. There are still many limitations on fabricating dentures using digital method while computerized production of fixed prostheses utilizing intraoral scanner and CAD/CAM technology has propagated rapidly. Recently the digital solution of fabricating removable partial denture by applying haptic input device, electronic surveying, and rapid prototyping was introduced. In this case presentation, five patients were treated with surveyed crown and removable partial dentures by this digital solution. Fit of dentures was excellent except for one case which showed morphological difference between the actual teeth and that of master cast by the erroneous impression process. There also was not any problem of stability and retention after adaptation in the clinical setting.

구강 내 디지털 인상채득을 통한 맞춤형 지대주와 시멘트 합착 후 나사형 임플란트 보철 수복 증례

홍용신,박은진,김선종,김명래,허성주,박지만 대한치과보철학회 2012 대한치과보철학회지 Vol.50 No.1

최근 디지털 인상채득 시스템이 개발되면서 이를 기존의 CAD/CAM 시스템과 접목한 인레이, 온레이, 크라운이나 간단한 계속가공의치 등의 고정성 보철물의 제작이 활발히 소개되고 있다. 그러나 임플란트 보철에서는 주로 기존의 아날로그식 인상채득 후 이를 스캔하여 제작하는 방법이 사용되어 왔으나, 구강 내 디지털 스캔한 데이터를 이용하여 나사형 보철물을 제작하는 술식은 아직 활발히 이루어지지 않았다. 이에 본 증례보고에서는 6명의 환자를 대상으로 구강 내 스캐너인 iTero를 사용하여 디지털 스캔을 시행한 후 그중 다섯명은 맞춤형 지대주와 시멘트 합착 후 나사형 임플란트 보철물(screw-retained implant prosthesis after cementation, or SCRP)을 제작하였고, 임상적으로 기능과 심미적인 측면으로 만족할 만한 결과를 얻었기에 이를 보고하고자 한다. Fixed dental prostheses such as inlay, onlay, crown, and bridge fabricated by CAD/CAM technique combined with digital impressions is getting popular due to the recent rapid progress of digital impression taking system. For the scope of implant prosthesis, however, digital intra-oral scan hasn’t been actively utilized for the fabrication of superstructures. In this case report, 6 cases of titanium-milled custom abutment based on the iTero intra-oral scan data were introduced, five of them were restored with screw-type prosthesis after cementation (SCRP) and the clinical results were satisfactory on restoring the function and esthetics.

축약형 월경전기평가서 표준화 연구 및 인터넷상에서 적용 가능성

이만홍,김지웅,이정현,김덕만 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.1

연구의 목적 : 연구의 목적은 축약형 월경 전기 평가서(Shortened Premenstrual Assessment Form: SPAF)의 신뢰도 및 타당도를 알아보고, 인터넷상에서의 적용 가능성을 알아보기 위하여 시행되었다. 방 법 : 월경전 불쾌장애 환자 28명과 월경 전 불쾌장애에 해당하지 않는 가임 연령의 여자 연구 대상자 27명을 대상으로 세브란스 여성 정신 건강 특수 클리닉 홈페이지를 통하여 축약형 월경전기평가를 시행하게끔 하였다. 월경전 불쾌장애의 진단은 2개월간의 전향적인 평가를 통해 내려졌다. 결 과 : 축약형 월경전기 평가서는 정동요인, 통증 요인, 수분 저류 요인으로 구성되어 있으며, 검사-재검사 신뢰도는 0.80으로 우수하였다. 내적 일치도(Cronbach alpha) 또한 0.91로 우수하였으며, 월경전기평가서 점수와 축약형 월경전기 평가서의 상관계수는 0.92로 나타났다. 월경 전 불쾌장애 환자군과 월경전 불쾌장애에 해당하지 않는 연구 대상군 사이의 축약형 월경정기평가서 점수도 유의한 차이가 있었고(t=5.57, p<0.001), 판별 분석상에서 축약형 월경전기 평가서 점수가 두 집단을 잘 판별할 수 있는 것으로 나타났다(eigenvalue : 0.60, canonical correlation coefficiency : 0.61, Wilk's lamnda : 0.63). 두 집단을 구분하는 최적 절단점은 27점으로 추정되었고, 이때의 민감도(75%)와 특이도 76.9%)는 비교적 우수한 것으로 나타났다. 결 론 : 이상의 결과들을 종합할 때, 축약형 월경전기 평가서는 신뢰도 및 타당도가 우수한 월경전기증상 평가 도구로서 인터넷상에서도 유용하게 사용될 수 있는 도구임이 시사된다. Objectives : The purposes of this study are to investigate the reliability and validity of shortened premenstrual assessment form and the applicability to internet interface. Method : The total of 55 subjects were included in this study. Among them, 28 subjects had premenstrual dysphoric disorder, and the other 27 subjects did not. All subjects performed the shortened premenstrual assessment form through internet interface in the homepage of Severance Woman Clinic. The diagnosis of premenstrual dysphoric disorder was determined by prospective assessment for 2 months. Results : The shortened premenstrual assessment form consists of 3 factors : affect, pain and water retention. The test-retest reliability of this scale was 0.80, and internal consistency(Cronbach alpha) was 0.91. The correlation coeffeciecy between scores of the premenstrual assessment form and the shortened premenstrual assessment form was 0.92. The difference of the scores of the shortened premenstrual assessment form between the group of premenstrual dysphoric disorder and the group of non-premenstrual dysphoric disorder was significant(t=5.57, p<0.001). Discriminant analysis also revealed that the shortened premenstrual assessment form was useful to differentiate between premenstrual dysphoric disorder and non-premenstrual dysphoric disorder(eigenvalue : 0.60, canonical correlation coefficiency : 0.61, Wilk's lambda : 0.63). The cut-off point to differentiate between two groups was 27, and sensitivity(75.0%) and specificity(76.9%) of this scale for premenstrual dysphoric disorder was acceptable. Conclusion : In summary, the shortened premenstrual assessment form appeared to be reliable and valid for the assesment of premenstrual dysphoric disorder. And the results of this study also suggest that the shortened premenstrual assessment form is a useful tool for internet interface application.

인지적 양식 및 스트레스 지각과 월경전기 증상와의 관계

김지웅,이정현,김덕만,이만홍 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.6

연구목적 : 월경전기 증후군의 원인에 관한 많은 가설 중에 여러 인지모델이 제시되어왔다. 즉, 부정적인 인지적 특징을 가진 사람이 월경전기 증상을 더 심하게 겪을 수 있다는 것이다. 본 연구의 목적은 월경전기 증상을 가진 여성에서 인지적 양식 및 스트레스 지각과 월경전기 증상과의 관계를 알아보고자 시행하였다. 방 법 : 18세 이상의 가임기 성인 여성 86명을 대상으로 하여 월경전기 평가서, 역기능적 태도 척도, 자동적 사고척도-부정형, 자동적 사고척도-긍정형, 스트레스 지각 척도를 작성하게 하였다. 이 중 21명은 2개월간의 전향적인 평가를 통해 월경전 불쾌기분장애로 진단하였다. 각 변수들간의 관계는 Pearson 상관계수를 구하여 검증하였다. 결 과 : 월경전불쾌기분 장애군에서 자동적 사고-부정형(r-.65, p<.01)과 스트레스 지각(r=.52)이 월경전기 증상과 유의미한 상관이 있는 것으로 나타났다. 월경전 불쾌기분장애에 해당하지 않는 대상군에서는 자동적 사고-부정형(r=.36, p<.01)이 월경전기 증상과 유의미한 상관이 있었다. 결 론 : 월경전기 증상은 비적응적인 부정적 인지 요소와 유의한 상관 관계를 보였고, 이러한 경향은 특히 월경전 불쾌기분장애 환자들에서 보다 두드러지게 관찰되었다. 이와 같은 결과는 월경전기 증후군 및 월경전 불쾌기분장애에 인지적 요소가 영향을 미침을 시사한다. 또한, 이들 질환의 치료에 있어 인지행동치료가 효과적일 수 있음을 제시한다. Objectives : The cognitive model has been suggested to explain the pathogenesis of premenstrual syndrome. In this model, it is suggested that negative cognitive style may contribute to the experience of severe premenstrual symptoms. We conducted this study to examine the relationship among cognitive style, perceived stress, and premenstrual symptoms. Method : Eighty six reproductive aged women older than 18 years were included in this study, to complete the Premenstrual Assessment form, Korean version of automatic thoughts Ques-tionnaire-Positive, Korean version of Automatic Thoughts Questionnaire-Negative, Korean version of Dysfunctional Attitude Scale, Perceived Stress Questionnaire. Among the subjects, twenty one were diagnosed to have a premenstrual dysphoric disorder which was determined by prospective assessment for two months. The relationships among the variables were analyzed by examining Pearson correlation coefficiency. Results : In the subjects without premenstrual dysphoric disorder, there exist significant correlation between the premenstrual symptom and the score of Korean-version of automatic thoughts Questionnaire-Negative(r=.36, p<.01). In the subjects with premenstrual dysphoric disorder, premenstrual symptoms had significant correlation to automatic thoughts Questionnaire-Negative(r=.65, p<.01) and Perceived Stress Questionnaire(r=.52, p<0.01). Conclusion : Our findings show the significant relationship between negative cognitive style and premenstrual symptoms. This relationship was more prominent in the subjects with premenstrual dysphoric disorder compared to ones without it. Our findings suggest that cognitive style and stress perception may influence on the severity of symptoms of premenstrual syndrome or premenstrual dysphoric disorder, and that cognitive behavior therapy is a possible effective therapeutic strategy for those with severe premenstrual symptoms.

林業稅制에 關한 考察 : 韓國, 日本, 美國의 制度에 대하여

金知洪,辛在萬,尹鐘和 江原大學校 森林科學硏究所 1985 Journal of Forest Science Vol.5 No.-

Introduced with a review of general taxation principles in Korea, the article provides details of the main type of tax related to forest resource management. The forest taxation of Japan and the United states is also examined to compare with the Korean legislation. The basic analysis is made upon provisions and interpretation of each tax, its history, and its influence on forest management. For Korean forest taxation, some points to be considered are as follows. 1) Since 500,000 won of special income tax deduction from total forest revenue is not likely to be remaining with its absolute value, it should be variable by socio-economic situation. 2) Income tax exemption from newly reforested land for 40 years may shorten rotation and induce heavy harvest cutting for long-term commercial timber species. 3) With a few exceptions, general forest managers are not offered favors in death tax and property tax for their forest land. Taxes have frequently been called the primary impediment factor for timber production because the effectiveness of incentives of programs has not been provided. Considered to the specific characteristics of forestry and resource conservation, Korean forest taxation should be revised and complemented to encourage forest management or maintenance.

농촌지역 노인들의 우울증상에 관련된 요인들의 특성

송미숙,전기홍,송현종,김정은,박승구,신상건,이동훈,정성현,최연주,최완철,최민규,황재철,홍지만 아주대학교 1997 아주의학 Vol.2 No.2

This study was performed to identify risk factors for depression among the elderly in a rural area. A survey was done for the elderly living in Gosam-myenn, Ansung-kun during the period of July 28, 1997 and July 30, 1997. Demographic and sodoeconornic characteristics, and functional and health Status were assessed using a structured questionnaire, and the level of depression was measured by GDS score. The data obtained were analyzed by frequencies, percentage, t-test, ANOVA, and multiple regression, and the results were as follows: 1. The total sample consisted of 133 elderly. Of them, 47 elderly (35.4%) showed significant depressive Symptoms. 2. The GDS score was the highest for the group over 85 years of age (p < 0.05). Those living alone or widowed showed lower GDS score than those living with someone or married (p < 0.05). 3. The GDS score was the highest in the absolutely dependent group, followed by the partially dependent group, and the independent group (p < 0.01). The elderly who perceived their health Status as excellent showed the lowest GDS score. In contrast, those who had more than five chronic diseases showed the highest GDS score. 4. The elderly receiving financial and emotional support from their family or friends showed lower GDS score compared to those without any support. 5. The economically dependent group showed higher GDS score than that of independent group. 6. The elderly who involved in leisure activities showed lower GDS score than those without any involvement. 7. In terms of risk factors for depression, we found that perceived health Status, subjective economic Status, leisure activities, living arrangement and financial support were inversely associated with GDS score, whereas labor support was positively associated with GDS score. Based upon the above findings, this study suggests that these risk factors for depression in the elderly should be taken into consideration for a comprehensive mental health program for the elderly living in the rural area.