외상성 횡격막 손상

안성국,이상목,이기형,고석환,김용호,박호철,고영관,조규석 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Fifty two cases of traumatic diaphragmatic injuries that we have experienced from Jan. 1973 to Oct. 1994 were evaluated. The following results were obtained. The age of the patient was ranged from 1 to 74 years. Male was 38 and female was 14 in number with a ratio of 2.7 : 1. The traumatic diaphragmatic injuries were due to blunt trauma in 35 cases(motor vehicle accident 25, fall down 8, press 1, kick by fight 1) and penetrating trauma in 17 cases(stab wound 15, shot wound 1, explosion 1). In the blunt trauma, the preoperative diagnosis of the diaphragmatic injury was possible in 25 out of 35 cases(71%) and in the penetrating trauma, 15 out of 17 cases(88%). In the blunt trauma, the repture site was located in the left in 22 cases(63%) and in the right in 13 cases(31%). In the penetrating trauma, the rupture site was located in the left in 9 cases(53%) and in the right in 8 cases(47%). In the blunt trauma, 20 cases(63%) were treated within 24 hours and in the penetrating, 15 cases(88%) within 24 hours. In the blunt trauma, the herniated organs into the thorax were stomach(7), omentum(6), spleen(6), liver(5), colon(4), small bowel(2) and in the penetrating, stomach(7), colon(6), omentum(3), liver(2), and spleen(1) were herniated. Injury severity score(ISS) of 35-blunt trauma ranged from 11 to 66 with mean value of 30.6. Mean ISS of survivors and nonsurvivors was 27.6 and 52.7 respectively. The diaphragmatic repair of 49 cases was performed with thoracic approach in 23 cases, thoracoabdominal approach in 7 cases and abdominal approach in 19 cases, and 3 cases were not operated. The postoperative complication and mortality were developed in 16 out of 49 cases(33%) and in 5 cases(9.6%) respectively, and the causes of death were hypovolemic shock(1), combined head injury(2), asphyxia(1), and pulomnary edema and renal failure(1). In conclusion, the injuries of the diaphragm should be suspected in all patients with severe blunt trauma or penetrating injuries at thorax and upper abdominal area near the diaphragm. All of the cases had associated injury and most of deaths were related to the severity of associated injuries.

Monoethanolamine을 이용한 화학 흡수법에 의한 지구온난화 가스 CO₂분리에 관한 연구

안성우,송호철,박진원,김영국 연세대학교 산업기술연구소 1997 논문집 Vol.29 No.1

This study is on the separation of Global warning effect gas, CO₂ by chemical absorption from mixture CO₂-N₂ which was modeled after flue gas of fire power plant. Investigation of optimum condition for absorbent was carried out by using sparged vessel apparatus. Through packed tower experiments, applicabilities of two absorption models were tested by comparing experimental result with theoretical values. Absorbent used was Monoethanolamine(MEA). Diethanolamine(DEA) and gas mixture was made in the mole composition of 15% CO₂and 85% N₂. Through experiments, optimum concentration of absorbent was found in the range of 4-5M. Values of rate of absorption were calculated by Film model and Danckwerts model respectively. Danckwerts model showed good agreement with experimental results. Therefore, this models is considered to be applicable to the CO₂separation process for flue gas from fire power plant.

소화성궤양의 임상적 고찰

박승국,허정욱,강영우,안성훈,이상곤 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.2

저자들은 1981년부터 1990년사이에 64,207명을 대상으로 내시경검사를 시행하여 8,814명에서 소화성궤양을 진단하여 다음과 같은 결론을 얻었다. 소화성궤양의 발생률은 13.7%였다. 위궤양과 십이지장궤양의 발생비는 1981년에는 1:0.9였으나 그후로는 1:1.1-1:1.5로 십이지장궤양의 발생비율이 높았다. 발생비율을 남녀별로 보면 위궤양의 경우에는 약 4:1 십이지장궤양은 3:1로 남자에서 많았다. 연령별로는 위궤양은 40대, 50대, 60대의 순서였고, 십이지장궤양은 30대, 40대, 20대 순으로 호발하였다. 위궤양은 위체부에서 대부분 발생하였다. In this century, very striking changes in incidence and prevalence of peptic ulcers, as well as in sexual proportion, in the age of the affected population and in the proportion of duodenal to gastric ulcers had occured and these epidemiological changes are ongoing. Therefore, we reviewed 8,814 cases with endoscopically proven peptic ulcers from 1981 to 1990. The results obtained are as follows; The prevalence of peptic ulcers among patients received endoscopy was 13.7%. The ratio of peptic ulcers among patients received endoscopy was 13.7%. The ratio of gastric ulcer to duodenal ulcer was 1: 0.9 in 1981, but after then the propotion of duodenal ulcer was higher in 1: 1.1-1:1.5. The ratio of male to female was about 4:1 in gastric ulcer and 3:1 in duodenal ulcer. The prevalence of gastric ulcer was highest in foruth decade and then fifth and sixth in order and the prevalence of duodenal ulcer was highest in thrid decade and then fourth and second decade in order. Most of the gastric ulcers were found at the gastric body.

자기공명영상검사 환자의 폐쇄공포증에 관한 연구

김영수,이성수,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

When patients expose their body in closing or narrow space, they are afraid and are increasing heart rate and have a difficulty in breathing. The MRI examination could cause claustrophobia to patients because the patients keep their body into narrow space in MRI examination. In order to investigate the positive rate of claustrophobia symptoms according to several factors, such as, sex, age, examination time, examination part and purpose of examination, 330 patients(174 male, 156 female) were studied. The collected data was statistically analysis χ_(2)-test for categorical variables. Multiple logistic analysis was used to evaluated the effect of variables on discomfort feeling and claustrophobia symptom. 1. The rates of examination purpose were 51.2% by tumor or the other disease, 21.0% by traffic accident or trauma and 14.2% by headache, respectively. 2. The discomfort experience in connection with examination part was influenced by patients position and location in the Bore. The first time, the patient feel discomfort, was mostly when the examination was started(64.1%), so patients comfort position had to be maintained from examination starting time. The patients discomfort feeling was no relation with age and gender. 3. Over 50% of patients felt discomfort and 8.8% of patients did excessively discomfort and 2.8% of the patients could take MR examination because of discomfort feeling. The kinds of discomfort included the examination part pain(40.9%), the uneasiness(14.3%), the sense of oppression and uneasiness(12.2%) and the claustrophobia(12%). 4. Fourth decade's patients who had the claustrophobia symptoms were more than other decade's, and female patients(9.6%) had the claustrophobia symptoms more than male(6.9%). In the 330 of study subjects, the patients experienced the claustrophobia symptoms was 27 patients(8.2%). 5. Logistic analysis of the presence of discomfort feeling during MRI examination with categorized age and other selected categorized independent variables(sex, educational level, examination part, admission, number of examination, examination time, and the purpose of examination) indicated that age(<50 vs >60) and purpose of examination(tumor or military affair vs other) were significantly contributed to dependent variables with 95% significant odd ration confidence interval. 6. Logistic analysis of the presence of claustrophobia symptoms during MRI examination with categorized age and other selected categorized independent variables indicated that only Purpose of examination(tumor or military affair vs other) were marginally significantly contributed to dependent variables(p=0.07). 7 Most of study subjects revcaled similar opinion about the prevention of the claustrophobia symptoms, and the substitution plan included that the minimum of sound(98.9%), the enlargement of the bore(98.3%), the radiology technicians guidance and explanation(69.9%), listening the music or set up mirror(65.8%), the open-bore(47.5%) and the peaceful atmosphere(19.8%).

일부 지역 제조업체 안전·보건관계자들의 지식 및 태도에 관한 연구

송영표,리갑수,이성수,안규동,이병국 순천향대학교 산업의학연구소 1996 순천향산업의학 Vol.2 No.1

The useful preventive measure for industrial accidents in manufacturing industries could be achieved through automation, education of workers on safety, proper work practice and etc. The success of prevention of industrial accident could be haevily relied on the awareness of accident prevention of workers and management personnel in each industries. In order to obtain general awareness of industrial accident in terms of knowledge and attitude and to provide useful information for the proper preventive measure of industrial accident, questionnaire survey was done with manufacturing industries in Chunan area which has 5 and more workers. Questionnaire with 50 question items were sent to 570 relevant personnels in 471 manufacturing industries. Out of 560, 460 relevant personnel replied to the questionnaire. The results obtained were as follow; 1. While most manufacturing industries(391 industries, 86.7%) under study reported that they had full time occupational safety and health personnel, only 30 manufacturing industries(6.5%) with legal requirement of such personnel did not have relevant ones. 2. Most popular position for the personnel of safety and health duty were section chief(33.2%), and 46.8% of safety and health personnel were in the age group of 30-39. Whereas 66.9% of them were titled as production chief and management chief. 3. Most safety and health personnel(98.5%) reported that disseminated information from professional organization of occupational safety and health were very useful to carry out their safety and health duties. 4. Eight one percent respondent received safety education from governmental organization or affiliated institute and most of them (97.3%) reported that such education was very effective. 5. While 61.8% of respondent reported the necessity of field inspection by inspector for routine and consultation, 30.0% of respondent wanted document inspection without real field inspection. But most respondent replied that such inspections were useful for conducting safety and health prevention. 6. While 93.7% of respondent thought that accident prevention were helpful for production, 88.8% and 86.0 of them replied that accident prevention could influence the cost of production and quality of products, respectively which eventually influenced the competitiveness of each industries. 7. Eighty five percent of respondent replied that accident could be prevented with educational, personal and material resources. 8. While 96.5% of respondent replied that their industries provided safety education, out of them 26.2% industries thought that their safety education were superficial. The most popular frequency of safety education was once per month(56.0%) and 31.0% industries provided once a week. On the other hand 13.1% of industries provided every day safety education on regular basis. 9. While 45.2% of respondent replied that employer had strong commitment for safety and health, 41.3% of respondent replied that there were some changes and progression of employer's attitude for safety and health issues. 10. While 49.2% of respondent replied the necessity of legal requirement of safety personnel, 45.8% of respondent replied that voluntary requirement for safety personnel were more practical and helpful for accident prevention. 11. The necessity of periodic health examination were replied from most respondent(90.0%) and 73.0% of respondent thought that periodic health examination were helpful for the promotion of worker's health, but 56.4% of respondent criticized that periodic health examination were superficial and needed revision of content and method of periodic health examination. 12. Most respondent(92.7%) agreed the necessity of environmental measurement and 64.4% of respondent had their confidence on the result of environmental measurement, whereas 56.7% of respondent replied that their industries were repaired and improved according to the recommendation of environmental measurement and 85.6% of respondent replied that some kind of countermeasure for the recommendation such as supplies of personal protective equipments were done.

전자부품 제조업 근로자들의 시력변화에 대한 연구

이용만,안규동,이성수,함정오,김화성,리갑수,이병국 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

근접작업이 시력약화의 원인이 될 수 있는가를 알아보기 위하여 전자부품을 제조하는 2개 사업장에서 1991년에서 1993년까지 입사한 근로자들 중에서 근접작업으로 인정되는 마이크로칩을 조립하는 근접작업자 306명을 조사군으로, 대조군은 세탁기 타이머 및 일반 기계기구를 조립하는 작업자 154명, 계 460명을 선정하였다. 이들 대상자는 1991년 입사자는 1993, 1994, 1995년 시력을 조사하였으며, 1992년 입사자는 1993, 1994, 1995년 3년동안 조사를 하였으며, 1993년 입사자는 1994, 1995년 2년간 시력을 조사하였다. 대상자 중에서 입사시 안경을 착용한 근로자는 82명(17.8%)이었다. 따라서 남자 근로자와 안경착용자를 제외한 여성 근로자들 335명만을 추적 조사하여 다음과 같은 결론을 얻었다. 조사군에서 입사시 시력 1.0 이상이었던 근로자의 분포는 취업 1년 후 약 25-35% 정도 감소하였으며, 2년후에는 약 40-60% 정도의 감소를 나타내었고, 3년 후 약 50-65% 정도로 감소하였고 4년후에는 약 65% 이상 감소하였다. 그러나 대조군에서는 1.0 이상의 시력을 보였던 근로자들의 비율이 취업 1년 또는 2년 후 15-30%의 감소를 보이고 있으나 그 이후에는 큰 변동이 없었다. 이들의 시력변화를 근무년수에 따라 알아보기 위하여 조사된 시력을 순위변수로 하여 Kruskall-Wallis 검정을 시행한 결과 조사군, 대조군 모두에서 근속년수에 따른 순위의 합의 평균이 년차적으로 유의하게 감소하였으나, 입사시부터 근속년수에 따른 조사군과 대조군과의 순위합의 평균에 의한 시력차 비교에서 입사시 조사군의 순위합의 평균이 유의하게 높았던 것이 근무기간에 따라 대조군의 평균이 높아지면서 통계적 유의성이 없고 대체적으로 1년 이후부터 변화가 적은 것으로 나타나 근접작업으로 인한 시력약화를 추정할 수 있었다. This study was carried out to investigate that the close distance works were associated with decreased visual acuity. 306 workers were subjects who had been recruited from 1991 to 1993 in two electronic parts manufacturing factories, and 154 workers were controls who had been employed from 1991 to 1993 in launder machine timer and general machine assembly factories. Subjects who had been employed in 1991 and 1992 were follow up from 1993 to 1995, and subjects who had been employed in 1993 were from 1994 to 1995. The male workers as well as glasses wearing workers were excluded. Only 335 female workers were followed up to study the change of visual acuity. The results were as follows; The rate of workers with visual acuity over 1.0 at recruit year in subjects group was decreased about 25-35% after 1 year, 40-60% after 2 years, 50-65% after 3 years, and 65% after 4 years. While, the rate of workers with visual acuity over 1.0 at recruit year in control group was decreased about 15-30% after 1 or 2 years, and there was no more additional visual acuity reduction after then. Kruskall-Wallis test was performed to investigate the change of visual acuity in subject and control group by work duration. The means scores of ranks in both group were significantly decreased by work duration. The mean scores of ranks in subject group at recruit year were significantly higher than those in control group at recruit year, but these differences were disappeared after 1 year work. Therefore, this suggest that close distance workers may be affected their visual acuity.

무보수 호흡용 보호구 착용이 2차 제련 연작업자들의 연폭로지표에 미치는 영향

이영구,황보영,리갑수,이성수,안규동,이병국 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

It is often impossible to improve working condition in small scaled lead industries due to inherent old work process and lack of capital to improve it. This is particularly true in secondary smelting industries in Korea. Alternative ways to protect workers in these industries are respiratory protection and job shift if at all possible to less harmful workplace. This study intended to evaluate the effect of maintenance free respirator and job shift of lead workers to other non-lead workplace on the level of lead exposure of workers in terms of blood zinc protoporphyrin as an index of lead absorption and intoxication of lead workers. Seventy three workers of one secondary smelting industry whose work duration was more than 4 months were studied. All workers were classified into 4 groups such as managemental workers(8), non-lead workers(14), lead workers(44) and shift workers(7). Personal data such as age and work duration were collected and air concentration of lead in each workplace were also measured. Blood ZPP was chosen as an index of biological monitoring and was measured regularly once a month for 5 months study period. The results obtained were as follows: 1. There were no significant differences of mean blood ZPP during 5 months study period in management workers and non-lead workers showing the range of 23.1-26.5 ㎍/100ml and 22.2-24.2 ㎍/100ml respectively. 2. Rapid reduction of mean blood ZPP from first month (203.0 ± 106.7 ㎍/ 100ml) to third month (128.4 ± 75.1 ㎍/100ml) was noticed and after 3 months period there was no further reduction of blood ZPP in lead workers. 3. The initial mean blood ZPP of shift workers who moved to non-lead workplace was 394.3 ± 114.9 ㎍/100ml and their mean blood ZPP were steadily decreased every month from 344.3 ± 98.4 ㎍/100ml of first month to129.9 ± 33.5 ㎍/100ml of 4th month). 4. The average reduction rate of blood ZPP based on initial blood ZPP was 37.0% in lead workers for 3 months period and 67.1% in shift workers for 4 months period. With above results it was observed that respiratory protection and work shift could protect lead workers from lead exposure by reducing lead exposure in secondary smelting industry which had fairly bad working condition. But for a complete prevention of lead poisoning, it has certain limitation and should be used as an interim method until fundamental engineering control of workplace.

5년간 집단 검진에 의한 연취급 사업장 근로자들의 건강수준 평가

차영수,이성수,안규동,한구웅,이병국 순천향 대학교 산업의학연구소 출판부 1995 순천향산업의학 Vol.1 No.1

To evaluate the health status of workers in lead using industries under supervision by Soonchunhyang University Institute of Industrial Medicine as part of program of group occupational health service and find out longitudinal changes of health status of lead workers through the service for 5 years from 1989 to 1993, authors analyzed 5 years's periodic health examination data which comprised 29 lead using industries with 40,035 total cumulative number of workers. Selected variables for this study were screening results of general health examination and final results of confirmative health examination for the general health examination which dealt with office workers and blue collar workers with no exposure of hazardous condition. For the special health examination, zinc protoporphyrin in whole blood (ZPP) and screening results of special health examination were selected for study variables. For the confirmative special health examination with screening positive workers, blood lead(PbB), delta-aminolevulinic acid in urine, ZPP, and final result were selected for study variables. Information on age, sex, and type of industries were also collected. The results obtained were as follows; 1. The five years screening positive rate for general health examination was 13.7% and 5 years rate for C category which did not need further confirmative recheck was 5.2%. 2. While the proportion of liver disease in C category in primary general health examination was 49.2% those of anemic disease and hypertensive disease were 23.3% and 27.5% respectively. 3. Five years screening positive rate and negative rate for storage battery industries, secondary smelting related industries, telecommunication related industries and other industries were 83.4% and 12.4 %, 76.5% and 17.5%, 75.5% and16.4%, and 79.5 and 14.4% respectively. 4. Screening positive rate for 5 years were increased as age increased from 9.0%(age less than 30 years ) to 21.1% (age more than 40 years). 5. Only 22.1% of screening positive workers for 5 years general health examination were diagnosed as confirmed general diseases and 33.1% were revealed as normal. The rate of confirmed general diseases were differed by the type of industries and they were increased by age increased. 6. The rate confirmed general disease and non-disease in screening positive of liver, cardiovascular, tuberculosis and chest, anemic and renal disease category were 25.5% & 14,5%, 22.8% &37.2% 21.5% &23.0% 62.0% & 7.0%, and 16.5% & 53.9% respectively. 7. The 5 years prevalence rate of confirmed general disease(D_(2)/total workers) and prevalence rate of abnormal finding(C+D_(2)) were 3.21% and 14.9% as a whole. By the screened disease category, those rate were 1.23% &6.89% for liver disease, 1.17% & 5.43% for cardiovascular disease, 0.96% &1.64% for tuberculosis and chest disease, 0.76% & 1.02% for anemic disease and 0.03% & 0.06% for renal disease respectively. 8. The five years screening positive rate of all lead workers with the criteria of the measurement of ZPP(>=100㎍/㎗) was 10.2% (female lead workers :25.5% male lead workers :8.1%). The positive rate has tendency to decrease year by year from 1989 to 1993. The phenomenon of decrease of rate was significant in storage battery industries, but not apparent in secondary smelting related industries. 9. The proportion of lead poisoning (D_(1)) among screening positive of lead workers was 14.9% for 5 year special health examination and rest of screening positive were diagnosed as high lead absorption. White the proportion of D_(1) was 8.8% in storage battery industries, that was 23.9% in secondary smelting related industries. 10. The distribution of screening positive lead workers by the group of ZPP for 5 years as a whole was 48.3%, 20.9%, 20.5% and 10.3% in the group of ZPP 100-149㎍/㎗, 150-199㎍/㎗, 200-299㎍/㎗ and above 300㎍/㎗, respectively. 11. The proportion of screening positive lead workers whose blood lead were above 60㎍/㎗ and whose urine ALA were above 10㎎/ℓ were 53.3% and 61.4%, respectively. 12. The 5 year overall prevalence rate of lead poisoning (D_(1)/all lead workers) was 0.142%(female lead workers:0.116%, male lead workers:0.145). For the rate of high lead absorption((C+D_(1))/all lead workers) was 0.945%(female lead workers:2.36, male lead workers :0.756). The above prevalence was decreased in later year of study period than early year of study period.

유기용제 폭로 근로자의 자각증상에 관한 연구

엄영익,신혜련,우극현,안규동,이병국 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

To investigate the relationship of subjective symptoms of organic solvent exposed workers with their exposure level and urinary excretion of hippuric acid, 61 male workers who worked in 5 organic solvent using industries were studied. 89 workers were randomly selected from workers group for detailed health examination who visited hospital and had no exposure history to organic solvent as a control group. Personal air concentrations of organic solvent were checked for all organic solvent workers and urinary concentration of hippuric acid for both exposed and control group were also measured. Subjective symptom questionnaire of 31 organic solvent related item were provided to all workers and filled up by themselves and rechecked by medical doctor. The results obtained were as follows: 1. The overall prevalence rate of symptoms were significantly higher in exposed group than control group with statistical difference of 13 symptoms. 2. The overall prevalence rate of symptoms seemed to be increased by the exposure level of organic solvent. 3. The excretion of hippuric acid was more closely related to the level of toluene exposure than the level of mixed organic solvent exposure. 4. In the analysis of multiple stepwise regression using hippuric acid concentration as dependent variable and the concentration of each organic solvents as independent variables, only toluene had significant relationship with hippuric acid and none of other solvent did not affect on the concentration of hippuric acid. 5. In the analysis of multiple stepwise regression using symptom prevalence as dependent variable and the concentration of each organic solvents as independent variables, toluene had most significant effect to the symptom prevalence and the contribution of other solvents was minimal.

연폭로 근로자들에서 빈혈증 관련 인자에 관한 연구

황보영,김용배,김화성,이성수,안규동,이병국 순천향대학교 교수학습개발센터 2004 Journal of Soonchunhyang Medical Science Vol.10 No.3

Objectives : This study intended to obtain the interrelationship of lead exposure indices and anemia related factors for the better health management of lead exposed workers. Methods : 502 male workers in storage battery industries as lead exposed group and 106 male office workers as contorl group were selected for this study. The examined variables wer age, work duration, smoking and alcohol crinking habit, blood zinc protoporphyin concentraion (ZPP), blood lead concentration (PbB), urinary δ-aminoevulinic acid (ALAU), hemoglobin (Hb), hematocrit (Hct), serum calcium (S-Ca), serum iron (S-Fe), total iron binding capacity (TIBC), and percentage trasferrin saturation (PTS). Results : The means of ZPP, PbB ALAU in lead exposed proup were 58.4±35.7 ㎍/㎗, 27.6±10.9 ㎍/㎗, and 1.61±2.00 mg/ℓ, respectively. These three values in lead exposed group were significantly higher than control group (P<.05). The means of Hb, Hct, S-Ca, S-Fe, TIBC, PTS in lead exposed group were 15.3±1.1 g/㎗, 47.2±4.5 %, 9.4±0.4 ㎍/㎗, 124.0±67.5 ㎍/㎗, 317.1±68.5 ㎍/㎗, and 38.7±15.2 %, respectively. Hb, Hct, S-Ca, S-Fe, and TIBC in lead exposed group were significantly lower than contrl group (P<.05). PTS was no significant difference in lead exposed group and control group (P> .05). Hct, S-Ca, S-Fe, PTS were significant positive correlation with Hb and ZPP, corrected PbB, AlAU were significant negaitive correlation with Hb in lead exposed group (P< .05). On multiple regression using ZPP as a dependent variable and PbB, S-Ca and S-Fe as independent variables after adjustment for possible confounder such as age, smoking and drinking habit, Pbb, S-Ca, S-Fe and age contributed to ZPP. Conclusions : As the result of this study, it was suggested that inclusion of S-Ca, S-Fe, PTS measurement as a anemia screening test for lead workers was highly recommended for the effective prevention and early diagnosis of anemia.