서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1997)

김재홍,문득곤,김정수,김용준,임동진,박상훈,김희성,이민수,송기훈,김갑형,김형석,성소영,이인섭,김석우,황지환,조창근,김경문,부태성 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.3

Background : In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. Objective & Methods : For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1997. 99 strains of N. gonorrhoeae were isolated, among which 45(45.5%) were PPNG. Conclusion : The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 45.5% in 1997.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

코어안정화운동, 동방요법 및 병행처치가 골반변위에 따른 좌골신경통에 미치는 영향

김동호(Kim, Dong-Ho),김상현(Kim, Sang-Hyun),김성남(Kim, Sung-Nam),김재철(Kim, Jae-Cheol) 한국체육과학회 2019 한국체육과학회지 Vol.28 No.4

The purpose of this study was to confirm the effect of core stability exercise, dong-bang therapy, and combined treatment on reducing pain, pelvic correction and stress hormone concentration in patients suffering from sciatic neuralgia due to pelvic displacement. Middle aged(40~50age) suffering from sciatic neuralgia over 6 months were operated with core stability exercise, dong-bang therapy, and combined treatment 3 times a week for 12 weeks. VAS and X-ray was performed to collect pain scales and pelvic displacement data and cortisol and epinephrine concentration in blood were tested. 1. pain scale rate was reduced in all groups. especially, dong-bang therapy group and combined treatment group showed more directive pain reduce. 2. pelvic displacement improvement was not significant in core stability exercise group, and it was significant in dong-bang therapy group and combined treatment group. no significant difference was shown between dong-bang therapy group and combined treatment group. however, combined treatment group showed higher correction effect. 3. concentration of stress hormone was significantly increased in all groups after the first operation. after 12 weeks concentration level was reduced to same level before treatment. Dong-bang therapy and combined treatment improve pelvic displacement, and are effective treatments on reducing sciatic neuralgia due to pelvic displacement. combined treatment of dong-bang treatment and core stability exercise is considered an effective program of correction for pelvic displacement and maintenance.

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

당뇨병성 합병증을 가진 환자에서 혈증 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 조선의대 1998 The Medical Journal of Chosun University Vol.23 No.1

조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

3DFT-CISS를 이용한 감각신경성 난청 환자의 MBI

김성원,여상원,김상후,김종수,조재흥,이동희,이승균 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.7

한국인 제1형 당뇨병에서 체도 세포질 항체의 양성률 : 항GAD항체, 항ICA512항체, 항phogrin항체의 조합 측정으로의 대체 가능성 Possible Replacement with Combined Measurement of Anti-GAD, Anti-ICA512, and Anti-phogrin Antibodies

김경아,김동준,정재훈,민용기,이문규,김광원,진동규,고경수,김상진,이명식 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.6

연구배경:최근 당뇨병의 분류를 새로 제정함에 있어 자가항체가 양성이면 임상형에 상관없이 제1형 당뇨병으로 분류하자는 제안이 나옴으로써 자가항체의 중요성은 더욱 커질 것으로 예상된다. 특히 우리나라와 같이 비비만형인 제2형 당뇨병이 많은 나라에서는 당뇨병의 병인 규명에 자가항체가 중요한 위치를 차지할 것으로 사료된다. 자가항체 중에서 전통적으로 측정되어온 췌도 세포질 항체(ICA)는 표준화하기 어렵고 기술적으로 제한점이 많으며 현실적으로도 췌장 공여자가 적은 점 등이 문제로 알려져 있다. ICA의 대응 항원들로는 GAD(glutamic acid decarboxylase), IA­2(islet­associaated antigen­2;ICA512), IA­2β(phogrin)등이 있다. 이러한 대응 항원에 대한 특이적인 자가항체의 측정은 ICA에 비해 표준화되었으며 최근에는 방사면역측정법(radioimmunoassay;RIA)키드까지 등장하여 손쉽고 정확히 이를 측정할 수 있게 되었다. 연구자들은 한국인 제1형 당뇨병에서 측정법이 표준화 되어 있는 항GAD항체 및 항ICA512항체 조합(combimation)의 조합으로 ICA의 측정을 대신할 수 있는지를 조사하였고 더 나아가 항phogrin항체의 조합 측정으로 임상적 유용성이 있는지 보고자 하였다. 방법: ICA는 면역조직화학 염색법을 이용하였다. 항 GAD항체는 상업화 된 키드(RSR??, United Kingdom)를 이용하였다. 항 ICA512항체와 항phogrin항체의 측정은 in vitro transcription&translation한 후 이를 이용해 방사면역 침전법을 이용하였다. 대상 환자로는 전형적 제1형 당뇨병 76명, 지진형 제1형 당뇨병 22명, 제2형 당뇨병 39명이었으며 각 군간의 연령은 각각 22.8±14.0, 37.9±13.9, 45.3±12.3세였다. 결과:1)전형적인 제1형 당뇨병에서는 ICA의 양성률이 30%, RIA조합만의(항GAD항체 또는 항 ICA512항체 또는 항phgrin항체 한가지에라도 양성인 경우)양성률이 57%이었다. 지진형 제1형 당뇨병에서는 각각 18%, 50%이었다. 제2형 당뇨병에서는 각각 7.7%, 5.1%이었다. 2)각 군에서 ICA가 양성인 군에서 RIA조합 양성률을 보면 전형적 제1형 당뇨병에서는 96%, 지진형 제1형 당뇨병에서는 100%에서 양성이었고 제2형 당뇨병에서는 RIA 조합 양성이 없었다. 각 군에서 ICA가 음성인 군에서도 RIA 조합시 전형적 제1형 당뇨병에서는 40%, 지진형 제1형 당뇨병에서는 39%에서 양성이었고, 제2형 당뇨병에서는 5.6%에서 양성이었다. 3)전형적 제1형 당뇨병에서 ICA가 양성인 군(n=23)에서 96%가 RIA조합 양성이었는데 이때 각각의 RIA유형을 보면 항GAD항체 양성이 87%였다. 한편 항 ICA512항체 양성이 48%, 항phogrin항체 양성이 44%이고 항GAD항체 도는 항ICA512항체 양성이 96%를 차지한다. 지진형 제1형 당뇨병에서는 ICA가 양성인 군(n=4)에서는 항 GAD항체 양성이 3명, 항ICA512항체 양성이 1명이었다. 따라서 기존의 ICA를 RIA조합으로 대체할 수 있을 것으로 사료되었는데 이때 항GAD항체와 항ICA512항체의 조합이 도움이 되겠고 항phogrin항체의 추가적인 검사는 일부의 환자에서만 도움이 되리라 사료된다. 4)이환 기간에 따라 ICA와 RIA조합을 비교시 ICA는 차이가 없었으나 RIA조합의 양성률은 지진형 제1형 당뇨병에서 4년 이상의 이환 기간이 지나면 그 이전보다 떨어졌다. 5)발병 연령에 따라 ICA와 RIA조합을 비교시 ICA 양성률이 전형적 제1형 당뇨병에서 15세 이전에 발병한 그룹에서 그 이후에 발병한 그룹보다 유의하게 높았다. 결론:이상의 결과를 요약하면 항GAD항체 및 항ICA512항체 측정의 조합은 ICA보다 민감도가 높아 기존의 ICA를 대체함은 물론 임상적 이용에서 현격한 우월성을 보이며, 성인에서 발병한 비전형적인 당뇨병의 분류에도 도움이 될 것으로 사료되었다. 추가적인 항phogrin항체의 측정은 임상적 유용성이 없었다. Background : Type 1 diabetes includes all forms of autoimmune-mediated and idiopathic beta-cell destruction leading to an absolute insulin deficiency. Evidence of an autoimune pathogenesis was assessed by studying cytoplasmic islet cell antibodies (ICA), antibodies to glutamic acid decarboxylase (GADA), antibodies reacting with an islet tyrosine phosphatase-related molecule referred to as ICA 512 (ICA 512A), or its homologue phogrin (phogrin-A). In comparison with ICA, the best validation to assess the risk of type 1 diabetes, shows that a combination of antibodies to GADA with ICA 512A has the power to detect a majority of ICA and 97 ~ 100% of subjects who progressed to overt diabetes. These findings suggest the possibility of replacing the laborious ICA test in the screening programs to identify subjects at risk of progressing to type 1 diabetes or for classifying the stage of diabetes at the time of diagnosis. Up to now, it is unclear whether these results are applicable to the slowly progressive type 1 diabetes that appears to be more prevalent in Asian than in western countries. The prevalence of combined autoantibody testing (1≥ of GADA, ICA512A, or phogrin-A) was investigated in the patients with type 1 diabetes (typical and slowly progressive) and type 2 diabetes, and compared with that of ICA which is a more laborious and insensitive test. Methods : The ICA assay was performed using immunoenzymatic staining of frozen human (blood group O) pancreatic sections with serial dilutions of serum samples with peroxidase-labeled protein A. For the GADA determination, commercially available GADA radiommunoassay kits utilizing the ^125I-labeled recombinant GAD65 (RSR®, United Kingdom) as an antigen was used. Either ICA512A or phogrin-A were detected by a radioligand-binding assay after in vitro transcription and translation using the clone ICA512bdc or phogrin c DNA. Serum was obtained from 76 patients with type 1 diabetes(mean age 45.3± 12.3 years). Typical and slowly progressive type 1 diabetes patients had the disease for between 4.0±4.6 and 10.1±9.5 years, respectively at the earliest serum sampling. Results: 1) In typicaltype 1 diabetes, 30% of patients tested positive for ICA and 57% for the combined autoantibody test. In type 2 diabetes, 7.7% and 5.1% tested positive, respectively. 2) Ninety-six percent of ICA-positive patients expressed one or more of the 3 auto-antibody specificities in typicaltype 1 diabetes. Among the 53 ICA-negative patients with typicaltype 1 diabetes, 40% had one or more of these auto-antibodies. In the slowly pregressive type 1 diabetes, 100% of the ICA-positive and 39% of the ICA-negative patients expressed one or more of the 3 autoantibody specificities. 3) Of the 23 patients with ICA-positive typical type 1 diabetes patients, 87% had a positive result for GADA, 48% FOR ICA512A, 44% for phogrin-A, and 96% for GADA or ICA512A. Of the 4 patients with ICA-positive slowly progressive type 1 diabetes, three had a positive result for GADA, and 1 for ICA512A. 4) When the prevalence of combined autoantibody testing was analyzed according to the duration of diabetes, the prevalence in patients tested within 4 years after the diagnosis and more than 4 years after the diagnosis was 61% and 52%, respectively in typical type 1 diabetes. Furthermore, that for the ICA was 37% and 21%, respectively. In the slowly progressive type 1 diabetes, the prevalence of combined auto-antibody testing was 88% and 25%, respectively (p<0.05), while that of ICA was 25% and 13%, respectively. 5) In typical type 1 diabetes, ICA were detected more frequently in patients younger than 15 years of age (48%) than in older patients (23%) (p<0.05), while the prevalence of combined auto-antibody testing -was not different according to the onset age(65% vs 53%). Conclusion : Combined autoantibody testing for GADA and ICA512A is more sensitive that ICA in type 1 diabetes. Therefore, it could replace the laborious ICA measurement and may be useful for discriminating the etiology of adult onset a typical diabetes(J Kor Diabetes Asso 25 :430~445, 2001).

설사와 산혈증에 의한 신생아 메트헤모글로빈혈증 2례

김두권,김영진,김기호,고희신,김우택,최성민,이동석,권경배 東國大學校 醫學硏究所 1995 東國醫學 Vol.3 No.-

메트헤모글로빈혈증은 환원 효소계 결핍이나 환원되지 않은 비정상 메트헤모글로빈을 가지는 선천성 질환 및 후천성 산화성 물질이나 약제에 노출될 때 생기게 되나, 신생아에서는 산화성 물질에의 감수성이 높은 동시에 환원효소의 활성이 낮으므로 산화성 물질에의 노출이 없이 설사, 산혈증 및 감염증 등에 의해서 일시적 메트헤모글로빈혈증이 일어날 수 있다. 저자들은 발열과 심한 설사 및 청색증을 주소로 내원한 생후 18일, 생후 19일된 남아 2례에서 메트헤모글로빈 혈증을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Methemoglobinemia is characterized by generalized cyanosis without cardiac and pulmonary diseases. Methemoglobin, yielded by oxidation of hemoglobin iron to the ferric state, is nonfunctional and imparts a chocolate hue to the blood. The blood of normal healthy persons contains methemoglobin, but the intraerythrocytic methemoglobin-reducing system maintains its concentration less than 2% of the total hemoglobin. Methemoglobinemia is caused by the inherited disorders of methemoglobin metabolism and the accidental ingestion of oxidizing agents and infection. Fetal hemoglobin has increased susceptability to oxidation NADH diaphorase activity is reduced to 60% of adult levels in newborn erythrocytes. Acute diarrhea and acidosis further reduce the activity of the enzyme. We experienced two cases of methemoglobinemia due to acute diarrhea and metabolic acidosis who were admitted to the department of pediatrics at Dong-Guk University Hospital. No history of toxin exposure could be elicited. Case 1 concerns a 19-day-old male neonate who had irritability, fever, cyanosis, tachypnea, severe diarrhea, mild metabolic acidosis and grunting without cardiac and pulmonary diseases. On the day of admission, methemoglobin level was 52.3% of the total hemoglobin. After the treatment with methylene blue which was purified by 0.45㎛ of Nalgene syringe filter(Nalge Co.), its level was decreased to 6% of the total hemoglobin, and then it reached a normal level at the 5th day after admission. Case 2 concerns a 18-day-old male neonate who had fever, diarrhea, mild metabolic acidosis and cyanosis around lips without cardiac and pulmonary diseases. At admission, his level of methemoglobin was 25.3% of the total hemoglobin. After twice injection of methylene blue its level was decreased to 4.4% of the total hemoglobin, and then it reached 1.3% of the total hemoglobin at the 7th day after admission. So, we report it with a brief review of relevant literatures.

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.