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.

타액선의 점액유상피암에 관한 임상병리학적 연구

김종렬,정인교,성일용 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.2

The authors analyzed retrospectively the 19 patients with mucoepidermoid carcinoma of salivary glands who were treated at Department of Oral and Maxillofacial Surgery, Pusan National University Hospital from June, 1986 to September, 1998. The results obtained were as follows : 1. There were 4 males(21%) and 15 females(79%). Age distribution was wide and the mean age was 45.2. 2. Of all mucoepidermoid carcinomas of salivary gonads, 4 cases arose in the major salivary glands and 15 cases in the minor salivary glands. The incidence according to the anatomic primary site for minor salivary glands was 8 cases in the palate, 2 cases each arising in the tongue and floor of mouth and 1 case each arising in the mandible, buccal mucosa and the lower lip. 3. In histopathological classfication of mucoepidermoid carcinoma, 5 cases were low grade. 9 cases, intermediate grade and 5 cases, high grade. 4. Perineural invasion was observed 40% (2/5) in high grade and 22% (2/9) in the intermediate grade of mucoepidermoid carcinoma. 5. The incidence of cervical lymph node metastasis according to histopathologic grade was 40% (2/5) in high grade and 11%(1/9) in intermediate grade of mucoepidermoid carcinoma. 6. The lung was the commonest site for metastasis comprising 3 cases among 3 cases of distant spread of which 2 cases in high grade and 1 case in intermediate grade of mucoepidermoid carcinoma.

구강내 악성흑색종에 대한 임상연구

김욱규,허진호,황대석,김용덕,신상훈,김종렬,정인교 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.23

The prognosis of oral malignant melanoma is poor compared with cutaneous melanoma. It may be related to the difficulty of wide enough resection, the early hematogenous matastases, higher stage at initial diagnosis, tendency to growth vertically. In the view of histological differences between oral mucosa and skin, it is impossible use Clark’s and Breslow’s classifications for prognosis. The great problem is that there is still no consensus on the treatment due to rarity. Because data collection from case reports is considered to be the best source of information and should be pooled to anlalyze key determinants of outcome, We reported on 6 cases of primary malignant melanoma of the oral cavity which were diagnosed and treated in Pusan National University Hospital recently and reviewed the literature. Immunohistochemical study on S100 Protein, GP 100 (HMB-45) with biopsy was usable to confirm the melanoma. Neck dissection including wide excision is recommended if lymph node involvement is suspected. Additionally, adjuvant chemotherapy could be supporting therapy.

봉합재료에 따른 백서 미세혈관문합의 조직병리학적 연구

김종렬,성일용 大韓顎顔面成形再建外科學會 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.1

Purpose : Histopathologic observation was performed in order to determine which type of suture material is superior in microvascular anastomoses. Materials & Methods : The interrupted end to end anastomosis of the transected carotid arteries of 105 Sprague-Dawley rats, weighing 180 to 200g, were performed using 9-0 polypropylene (Prolene??, Ethicon, U.K), 9-0 polyglactin 910 monofilament (Vicryl??, Ethicon, U.K), and 9-0 polyamide( Ethilon??,Ethicon, U.K) under intramuscular Ketamine and Xylazine anesthesia(5mg/100g). In all cases, 10 to 12 sutures were placed to complete the anastomoses. The specimens were obtained at 1, 2, 3 days, and 1,2,4 and 6 weeks after the surgery and prepared with H&E and Van-Gieson stains and investigated the histologic changes in anastomotic sites under light microscope. The histologic changes we were concerned about were followings- thrombus formation, intimal edema, infiltration of inflammatory cells in media and adventitia, proliferation of endothelial cells and subintimal hyperplasia. Results :1. All of the anastomosed arteries were patent when they were exposed for examination. 2. Thrombus formation and intimal edema were most severe in Vicryl group, followed by Ethilon, Prolene group in order. 3. The inflammatory cells infiltrated to the media and the adventitia most severely in Ethilon group, followed by Vicryl, Prolene group in order. 4. There was little difference in proliferation of endothelial cells in each group. 5. Subintimal hyperplasia was greater in Vicryl group than the others, but there was no significant difference between the Prolene and Ethilon groups. Conclusions : On the basis of these observations, we could conclude that Prolene may be the better suture material for microvascular anastomoses regarding the tissue responses than Ethilon and Vicryl.

경부도상피판을 이용한 구강내 결손부의 재건 - 13증례분석

김종렬,강영기,서종천,성일용 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.3

The celvical flap, comprising skin, fascia, and platysma muscle, has significant application in the head and neck region after radical ablative surgery for cancer of the oral cavity. The flap may be used for recon-struction of the cheek, floor of the mouth, and lateral side of the tongue. This flap minimizes donor morbidity by use of cervical operation wound and flap size available is adequate for most oral defects and the procedure is relatively simple and time-saving. However the flap is not applicable in patients where there are large tissue defects and metastasis is suspected. We have used the celvical flap for its rapid, simple, and effective closure of oral defects after cancer ablation and found it is very useful for the reconstruction of relatively small oral defects.

장안모증환자의 술후 안정성 및 연조직변화에 대한 연구

김신원,김종렬 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.1

Purpose : The purpose of the present study was to evaluate postoperative stability and soft-tissue osseous relations of the long face syndrome patients. Methods : Twenty-five patients who had undergone bimaxillary surgery to correct long face syndrome at the Pusan National University Hospital were evaluated. The lateral cephalograms of preoperative, 1 week postoperative and at least 1 year postoperative were examined. Results : 1. The facial height of the long face syndrome patients were longer than normal Korean adults. 2. The most common malocclusion type of the long face syndrome patients in Korea was class Ⅲ. 3. Horizontal postoperative skeletal relapses were -0.64∼0.80mm in the maxilla, and -0.56∼0.48mm in the mandible. 4. Vertical postoperative skeletal relapses were 0.20∼0.56mm in the maxilla, and -0.80∼0.20mm in the mandible. 5. Postoperative soft tissue changes in long face syndrome patients were correlated with postoperative skeletal changes. So prediction schemes for postoperative soft-tissue changes were obtainable. Conclusion : It is hard to predict the exact direction and quantity of the postoperative skeletal relapse in long face syndrome patient's orthognathic surgery because of large standard deviation. But soft tissue change is predictable via prediction scheme.

광범위한 두개안면부 섬유골이형성증의 치험 2례

김기원,김홍식,정기돈,김종렬 大韓顎顔面成形再建外科學會 1996 Maxillofacial Plastic Reconstructive Surgery Vol.18 No.1

In Fibrous dysplasia(FD) of the jaws, the majority of cases can await the cessation of growth before surgical intervention, and it seems prudent to delay surgery whenever possible until growth has ceased. In craniofacial FD, however, the dangers of dystopia, dystopia and loss of vision may require early surgery to prevent or control cranio-orbital complications. Delaying surgery in those circumstances may be significantly detrimental to such patients. Conservative surgical management of FD is widely practised and we advocate an extension to this conservative treatment by combining surgical recontouring with appropriate osteotomies if indicated, to achieve an optimal esthetic and functional results in craniofacial FD. One case will be presented to illustrate the feasiblility of such combined treatment, to report the uneventful healing of osteotomies in the FD of the jaws, and to demonstrate the use of titanium miniplate fixation in dysplastic bone. The other case had expansile disease of the left facial and fronto-temporal bones and osteolytic change left mandible. This patient complained of severe spontaneous bleeding of left mandibular premolar area and it was suspected as central hemangioma of the left mandible and craniofacial FD. Angiogram disclosed generalized dilation of the external carotid artery and its branches, especially terminal branches of the left facial and minferior alveolar arteries. But no specific abnormalities, such as A-V shunt, venous lake, or early venous drainage, was seen. So it was diagnosed craniofacial FD with hypercellularity and generalized bony recontouring was performed via coronal and transoral approaches.

최근 5년간 응급실을 내원한 구강악안면외과 환자에 대한 임상적 연구

김종렬,정인교,양동규,박봉욱 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.2

his is a clinical study on patients who had visitied the Emergency Room of Pusan National University Hospital and then been treated in the Department of Oral and Maxillofacial Surgery during recent 5 years, from 1992 to 1996. The results were as follow ; 1. The total number of patients was 2,680 and the ratio of male to female was 1.96:1, The highest monthly incidence was shown in September(12.1%) and October(10.5%) and the age distribution peaks was the third decade(24.3%) , followed by the first(23.1%) and the fourth decade(17.2%). 2. Soft tissue injury group(29. 1%) was the most prevalent, followed by tooth injury group(16. 1%), facial bone injury group (16.0%), toothache group(11.2%), socket bleeding group(11.1%), infection group(9.8%) and TMJ dislocation group(5.9%). 3. The percentage of in-patients and out-patient were 21.6% and 78.4%, respectively. The frequent causes of admission were facial bone fracture(73.8%) , infection(20.8%) and soft tissue injury(4.8%) in order. However, soft tissue injury was the most frequent cause in out-patient, followed by tooth injury(20.5%), toothache(14.3%), socket bleeding(14.2%) and TMJ dislocation(7.6%). 4. In the facial bone injury group, the mandibular fractures(70.6%) showed the highest incidence, followed by zygomatic bone and arch fractures(7.5%), maxillary bone fractures(4.0%) and nasal bone fractures(4.0%). 5. In the mandibular bone fracture, the most common location was symphysis(36.7%), followed by the mandibular angles(33.1%) and the condyles(21.8%) 6. The common causes of facial bone fractures were violence, fall and traffic accident in order. 7. The common causes of soft tissue injury were fall down, fight and traffic accident in order and the highest incidence was observed in infants before the age of 10 years(44.0%). 8. In the group of tooth injury, tooth luxation(38.5%) showed the highest incidence followed by tooth fracture(33.2%) and tooth loss(17.1%). The common causes of tooth injury were fall, fight and traffic accident in order. 9. In infected patients group, the ratio of in-patients to out-patients was 1 : 1.28, Buccal(24,7%) and infraorbital space abscess(23.3%) showed the highest incidence. 10. The pain caused by dental caries(39.0%) and pericoronitis(26.6%) showed high incidence in the toothache group. 11. The high incidence was observed during third(34.0%) and fourth (24.5%) decades in TMJ dislocation group. 12. In the group of socket bleeding patients, 92% was post-operative hemorrhage and 8% was accompanied with other systemic hemorrhagic diseases.

구개인두 부전증 16증례의 임상적ㆍ방사선학적 연구

김종렬,박봉욱 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.5

Velopharyngeal adequacy is the ability of speech mechanism to create a seal between the oral and the nasal cavities during speech. The basic components of the velopharyngeal mechanism are the soft palate, the lateral pharyngeal wall, the posterior pharyngeal wall, associated musculature of the soft palate and pharyngeal wall, and the adenoid mass. If velopharyngeal inadequacy exists, the complete seal cannot be obtained during speech, resulting in hypernasal speech quality. This report is the clinical and cephalometric study of 16 consecutive cases of velopharyngeal inadequacy which were corrected by superiorly based pharyngeal flaps with lateral port control. The summarized results were as follows; 1.The total number of patients was 16(11 males, 5 females). They all showed hypernasality and nasal emission at preoperative period. 2.Hypernasality and nasal emission were shown in 13 and 5 patients respectively at immediate after operation, and decreased as 4 and 2 respectively at 6 months after operation. 3.Most patients showed snoring after operation and slowly decreased during follow-up periods. 4.During follow-up periods, the pharyngeal flap was slightly elongated at its horizontal length and moved inferiorly at its attached base. But this change was not as significant as it influenced on the clinical results.

양악 수술 시 상악골 상방 이동에 따른 상기도 변화

김용일,박수병,김종렬 대한치과교정학회 2008 대한치과교정학회지 Vol.38 No.2

Objective: The purpose of this study was to evaluate the upper airway dimensional change according to maxillary superior movement after orthognathic surgery and to identify the relationship between the amount of maxillary movement and upper airway dimensional changes. Methods: The samples consisted of 24 adult patients (9 males and 15 females) who had a skeletal discrepancy and had received presurgical orthodontic treatment. They underwent Le Fort I superior impaction osteotomy and mandibular setback surgery. Cephalometric x-rays were taken at 3 stages - TO (before orthognathic surgery), T1 (just or within 2 weeks after orthognathic surgery), T2 (6 months after surgery) Results: 1, Pharyngeal airway space (PAS (R)-nasopharynx) was decreased after surgery (T1) but recovered at 6 months after surgery; 2, Pharyngeal airway space (PAS (NL)-palatal plane) was increased after surgery and at 6 months after surgery; 3, Pharyngeal airway space (PAS (OL)-occlusal plane) was increased at T1 and was decreased at T2; 4, Soft palate thickness was increased at T1 but it became the same or thinner at T2; 5, There is no statistically significant relation between the amount of maxillary superior movement and pharyngeal airway space. Conclusions: These findings suggested that the maxillary superior movement of about an average of 4.40 ± 1.14 mm did not affect upper pharyngeal airway space changes. 양악 수술 시 상악골의 상방이동을 시행하였을 경우에 상기도의 공간적 구조변화를 평가하기 위하여, 술전, 술후, 술후 6개월 후의 간격으로 두부규격방사선사진을 촬영하여 그 변화량을 분석해 보았다. 술전 교정치료를 시행하여 상악은 Le Fort I 골절단술로 상방이동 시행하였고 동시에 하악은 후방이동 시키는 수술을 시행 받은 24명을 대상으로 하였다 (평균 연령 22세 1개월, 남자 9명 여자 15명). 상악골 상방이동에 대한 상기도 공간의 변화와 그에 따른 관련성을 조사한 결과, PAS (R)부위는 술후(T1) 감소하였으나 (P < 0.01) 술후 6개월 후(T2)에는 다시 증가하여 술전과 비교 시, 크기 변화를 관찰할 수 없었고, PAS (NL) 부위는 술후(T1)와 술후 6개월 후(T2)에서 유의성 있는 크기 증가를 보였다. PAS (OL)의 경우, 술후 (T1) 증가를 보이다가 술후 6개월 이후(T2)에서 감소하였다. 연구개의 두께는 술후 (T1) 증가를 보이다가 6개월 이후 (T2) 처음과 같거나 약간 감소하는 것으로 나타났으며 FH-uvular 각도는 술후 6개월 이후 증가하였다. 또한 상악골 상방이동에 대한 상기도 공간의 변화를 회귀분석 시행한 결과 양악 수술 시 평균 4.40 ± 1.14 mm의 상악골 상방이동은 양악 수술 후 상기도 공간의 변화에 큰 영향을 미치지 않는 것으로 나타났다.