레미콘 타설 작업 중 발생한 피부 궤양 1례

조수헌,한상환 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.1

The case was described of a 43 year old male who developed burns of the both shins as a result of handling wet cement. After wet cement was spilled into the rubber boots he was wearing, he experienced painful erythema of both lower legs. Several weeks later, medical examination revealed dirty and granulated ulceration of the both shins. The largest ulcer, about 18 by 10 centimeters, was located on the anterior aspect of left lower leg. We concluded that this skin problem resulted from the extreme alkalinity of calcium hydroxide in wet cement, combined with the effects of pressure and occlusion against the skin.

수산물채취 잠수부에서 발생한 중증감압병 37예 분석

조수헌,양대현,최헌 大韓産業醫學會 1989 대한직업환경의학회지 Vol.1 No.1

1986년 12월부터 1988년 11월까지 2년간 지방공사 강남병원 고압산소치료센타에 내원하였던 489명의 감압병환자중 신경계증상 등 중증증상을 보인예는 39명이었다. 이중 수산물채취 잠수작업중 중증감압병에 이환되어 미해군 재가압치료표에 따라 치료가 끝난 37명에 대하여 일반적 특성 및 잠수의학적 특성에 관한 자료를 조사하였다. 중증감압병환자의 67.5%가 25∼34세 연령층에 있었으나 10.8%는 45∼49세의 고연령층 이었다. 1년 미만의 잠수경력을 가진 예가 21.6%이었으며, 잠수기술은 70%가 체계적인 교육보다는 현장에서 잠수작업을 거들면서 기술을 습득하였다. 감압병 발병당일의 잠수형태에서는 31∼50m의 수심에서 2∼8회의 반복잠수 후에 흉부통증 또는 하지감각장애 등의 증상이 나타났는데, 증상발현은 수면부상후 30분이내에 83.7 %가 그리고 3시간이내에 100% 나타났다. 증상발현후 재가압치료를 받기까지의 경과시간은 평균 18시간으로, 재가압치료를 받아 완치된 경우에 있어서는 평균 12일의 입원기간중 11.3회의 고압산소요법을 실시하였다. 중증감압병의 경과 및 회복에는 발생전날의 반복잠수와 주증상발현후 재가압 치료까지의 경과시간이 지연되는 경향을 보였다. Hospital records were reviewed for 486 divers who have been diagnosed as decompression sickness(DCS) at Kangnam General Hospital between December 1986 and November 1988. Among 39 cases classified as serious DCS(type II), the patients had been fishery diving in 97.4% of the cases. The ages of the afflicted divers ranged from 22 to 47 years, with a mean of 31.5% years. The divers were experienced being less than one year in 21.6% and 70% of them learned diving skill by self-taught. In 86.5% of the cases the divers had made multiple divies ranged in depth from 31 to 50 meters. Thirty-one(83.7%) of the patients noted their symptoms within 30 minutes of surfacing. The spinal cord was most often affected, and the most common symptoms were 'numbness' or 'tingling' in one or more extremities and discomfort or pain on the chest. Recompression treatment was delayed for 18 hours in average after the onset of dysbaric symptoms and this treatment is more likely to be effective the sooner that it commences after the onset of dysbaric symptoms.

해부학 실습에 의한 의과대학생들의 formaldehyde 폭로 정도와 formaldehyde 과민반응에 대한 조사연구

조수현,김헌,남윤정,김용대 충북대학교 의과대학 충북대학교 의학연구소 1993 忠北醫大學術誌 Vol.3 No.1

Formaldehyde induces not only irritation symptoms of eyes and respiratory tract but hypersensitivity reactions, such as contact dermatitis, allergic rhinitis, and asthma. To estimate the levels of exposure to formaldehyde during cadaver dissection in anatomy laboratory and to investigate the prevalence rates of irritation symptoms, allergic rhinitis and bronchial asthma, air concentrations of formaldehyde within cadaver dissection room were measured, and self-administrative questionnaire and enzyme linked immunosorbent assay(ELISA) were performed upon medical(n=182) and premedical students(n=69). For measurement of air formaldehyde level, chromotropic acid method(NIOSH method 3500) was used. Formaldehyde was conjugated to human serum albumin, and used as antigen in ELISA after identification of conjugation with immunoelectrophoresis. Prevailing symptoms during cadaver dissection were soreness of eyes or throat(92.9%), lacrimation(74.3%), rhinorrhea(49.7%), and sneezing(32.2%). Mean titers of IgE and IgG antibodies specific to formaldehyde-human serum albumin conjugate(F-HSA) of medical students were higher than those of premedical students. However, there was no case whose titers of anti-F-HSA antibody were higher than the twice of those of anti-HSA antibody or higher than the twice of the mean titers of premedical students. These results suggest that medical students were exposed to relatively high concentration of formaldehyde, but few asthma or allergic rhinitis were induced by formaldehyde exposure during cadaver dissection practice.

사업장 소음 폭로에 의한 일과성 역치 상승과 회복

조수헌,하미나,한상환,주영수,성주헌,강종원,윤덕로,송동빈,이명학,김선태 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

To determine the recovery time from noise-induced temporary threshold shift(TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employee with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0∼2 hours, 5∼7 hours, 14∼16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0∼2 hours after noise exposure and 5∼7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000Hz, 2000Hz and 8000Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.

가스크로마토그래피를 이용한 요중 마뇨산 측정시 새로운 시료 전처리 방법의 검증

조수현,임용현,김선민,권호장,하미나,한상환 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.1

Urinary hippuric acid was analyzed by gas chromatography/mass spectrometry method. A simple and economical derivatization procedure using excessive methanol in acidic condition was adopted to esterify hippuric acid. Quantitative analysis was performed with two internal standards, heptadecanoic acid and hydrocinnamic acid, to evaluate the derivatization procedure as an analytical method. Using the standard addition method, linear and reproducible calibration curves were obtained for both internal standards. Calibration experiment showed that good quantitative result could also be obtained with the calibration curve obtained without urine matrix. Recovery rates for the urine samples were in the range of 95.6∼111.4%. Using hydrocinnamic acid as internal standard, analysis time could be reduced.

幼兒自閉症에 있어서 엔도르핀系와 社會性發達에 關한 硏究

曺洙哲,徐維憲,金憲植,金星秀,崔雄 서울醫大 1990 精神醫學 Vol.15 No.4

환경오염에 대한 보건학적 접근 : 의학적 감시체계

趙秀憲 대한의사협회 1998 대한의사협회지 Vol.41 No.10

아연 용융 도금 작업 근로자의 카드뮴 폭로 가능성에 관한 조사연구

조수헌,김헌,김선민 大韓産業醫學會 1991 대한직업환경의학회지 Vol.3 No.2

A 49 year old male zinc galvanizing worker was presented under the impression of cadmium poisoning in May 1988, but there has been many controversies on the fact. To indentify his cadmium poisoning, we made physical examination and laboratory workup on his previous collegues who worked in same manufacturing process with him as an exposure group and on office-men of the same company as a control group. We reviewed his medical records, autopsy findings, and laboratory findings including cadmium level in blood, urine, and kidney. Because his blood, urine and organ cadmium levels show great variance between laboratories, validity of data of some laboratories were suspected. His autopsy finding was not correspondent to cadmium poisoning. Blood and urine cadmium level and urine β₂-microglobulin concentration corrected by urine creatinine concentration of his previous collegues were not significantly different from those of office-men. In conclusion, it is doubtful that he was cadmium-poisoned and even if he was cadmium-poisoned, occupational exposure might not be related.

직업성질환 감시체계의 계획과 관리

조수헌,홍윤철,임종한,장성실,천병철 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.1

직업성 질환에 관련된 다양한 진료를 체계적으로 수집하고 관리하여 직업성질환의 예방 목적으로 이를 활용하고 자하는 노력이 우리나라에서도 이제 다양한 방법으로 시도되고 있다. 최근의 자료 시스템의 구축과 관리 방법의 향상은 새로운 직업성 잘환감시방법을 개발하게 하여 직업성질환과 손상을 예 방하는데 크게 기여하고 있다. 우리나라에서도 기존의 산업보건사업의 성과를 계승하면서, 외국의 직업성질환 감시의 여러 경험을 비판적으로 수용하여 한국적인 직업성질환 감시 모델을 구축해야 할 것으로 생각된다. 자발적인 지역차원의 직업성질환 감시체계들이 틀을 잡아가고 있는 이 시점에서 본격적으로 직업성질환 감시체계 수립을 위한 전략과 구체적 방법론을 마련하고 공유하여야 할 필요가 있다. 이를 위하여 우리나라의 직업성질환 감시체계를 구축하는데 기초가 될 수 있는 직업성질환 감시체계의 계획과 관리에 대한 내용을 정리하였다. 이러한 감시체계를 우리나라에 정립하려는 노력들의 일환으로 최근 직업성질환감시연구회의 결성 및 각 지역의 직업성질환 감시체계의 운영 등이 조금씩 결실을 맺어가고 있어 간략히 소개하면 다음과 같다.첫째, 최근에 인천, 천안, 대전, 여천, 구미 등에서 지역단위의 직업성질환 감시체계를 구축하고 있고 한국산업안전공단에서는 특수건강진단과 작업환경측정 자료를 전산화하여 이를 직업성질환 감시에 사용하는 전국단위의 감시체계와 천식, 근골격계질환, 피부질환 등 질환별 감시체계 등이 시도되고 있다.둘째, 이러한 움직임은 과거에 비하여 한층 발전된 양상이고 바람직하지만 이제는 국가적 차원에서 직업성질환 감시체계를 어떻게 설정하고 조율할 지를 고민하고 계획하여야 할 때이다. 즉 한국산업안전공단과 지역단위 직업성질환 감시체계들의 역할분담과 상호 정보의 교류 등이 정리되어야 이를 바탕으로 유기적인 국가 직업성질환 감시체계가 구축될 수 있다.셋째, 이를 위하여서는 직업성질환 감시체계 구축의 방법론을 서로 교류하고 공유할 필요가 있으며 나아가서는 이를 표준화하여 기본적인 자료의 교류가 원활하게 이루어질 수 있도록 하여야 한다. 이러한 역할은 최근에 결성된 직업성질환감시연구회와 산업안전보건연구원, 그리고 대한산업의학회, 산업간호학회, 산업위생학회 등이 협력하여 학술적인 작업과 함께 실무적인 지침을 만들어나가도록 하는 것이 바람직할 것이다.

서남해안 지방에서 발생한 Vibrio vulnificus 감염의 임상적 고찰

조남수,김춘호,김성중,김용배,조수형,안태훈 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: V. vulnificus infection in found between May and October when the man who has hepatic disorder or immunity disorder eats raw shellfish and it causes the systemic symptoms such as sudden fever, chilling, shock and stupor and local skin lesions like bleb and necrosis. This disease has 46∼61% of fatality rate in spite of intensive treatment. This study conducts the examination of history, epidemic study, ingesting raw fish and bacteriologic investigation in the patients with similar clinical symptoms to the above and examines the diagnostic dorrelations. Method: It is conducted with 31 cases who admitted at emergency medical center of Chosun University Hospital from May of 1995 to September of 1998 and are suspected to have V.vulnificus infection. It analyze bacteriologic examination, the survey of residence, eating raw shellfish, hepatic disorder, alcohol drinking habits and skin lesion. Results: 1) The rate of male and female is 15.5:1 and in the age, 18 cases are in fifties, seven are in forties and six are over sixties. 2) Clinically, V.vulnificus is detected in 20 of 31 cases which is suspected to have V.vulnificus infection and it is not detected in 5 cases. Other bacteria are detected in 6 cases and they include staphylococcus aureus, pseudomonas species, β-hemolytic streptococcus and E-coil. 3) In local distribution, Kohung has 10 cases, Shinan and Mokpo have six, Haenam and Kangjin have five, Yongkwang and Muan have five, Naju and Yongam have five and Kwangju has one. 4) Eating fishes and raw shellfishes is found in 31 cases. In the kind of shellfishes, eating raw clam is 10 cases, raw thin-shelled surf calm is 8 cases, raw oyster is 5 cases and sliced raw fish is 4 cases and pickled sea foods are 4 cases. 5) The cases with hepatic disorder are 23 and 15 cases with heavy alcohol drinking Carrier are included. The cases with Diabetic Mellitus are four and those with pulmonary tuberculosis are two. Two cases have not basal diseases. 6) On the opinion of skin lesion, 20 cases show vesicular necrosis, 7 cases have dendriform erythema, 3 cases have papule and one case doesn't show clear skin lesion. Conclusion: When V.vulnificus infection is detected, it is fatal and those who have hepatic disorder or heavy alcohol drinking habit must avoid eating fishes and shellfishes raw in summer. It is important to have emergency treatment for the patient whose V.vulnificus infection is suspected. It is considered that the administration of initial antibiotics is effective by generalizing the clinical symptom, epidemic opinion and patient history even before the results of bacteriologic confirmed.