신체장애 평가에서 유방의 법적 지위 - 장기 해당 여부, 수유장애, 노동력상실에 대하여 -

김봉겸,Kim, Bong Kyum 대한의료법학회 2017 의료법학 Vol.18 No.1

최근 들어서면서 유방에 대한 수술이 종류가 확대술 축소술 재건술로 대별되고 다양해지면서 이에 따른 원치 않은 수술성과에 대한 분쟁이 증가상태에 있으며, 이로 인한 배보상 문제가 최종적으로 대두되면서, '원치 않은 수술성과'를 '수술 후의 문제점' 보다는 "장애'로 보는 관점이 증가되면서, 신체장애 평가에서 유방의 흉부 장기 해당 여부에 따른 노동력상실률이 직접적으로 거론되기에 이에 대한 견해를 발표하고자 한다. 이를 위해, 법령에서 나오는 용어의 사전적 정의 및 의학적 제반 사항을 살펴보았다. 흉부 장기에 유방 포함 여부의 혼란은 용어 선정 후 그 해석이 시대 변화와 맞물려 유발된 것으로 생각된다. 법령에서의 자구 해석을 살펴보면, 유방은 흉부 장기에 해당되지 못함으로 규정된 것으로 사료되며, 수유장애는 낮은 출산율과 실제로 모유수유하는 경우가 현저하게 줄어들고 있는 상황에서 다수의 의견이라고 주장 강조함이 약화되고 있으며, 모유수유를 노동으로 볼 수 있는 유모로서의 직업도 현재 존재하는지 조차 모르는 실정이다. 이런 이유로, 유방을 흉복부 장기 해당 여부에 대한 논란을 잠재우기 위해서, 포함시키려면, (1) 법령집의 용어를 교체하거나(흉복부 장기에서 (ㄱ) 흉복부를 '흉복부 및 흉복강'으로 그리고 (ㄴ) 장기를 '장기 및 기관'으로), (2) 여러 법령에서 용어 변경은 어렵기 때문에, "산업재해보상보험법 시행규칙 [별표 제5호] 신체부위별 장해등급 판정에 관한 세부기준(제48조 관련)"에 유방을 예외적으로 포함시키면 될 것이라고 생각해 본다. 그러나 피부부속기관인 유방을 흉복부 기관 혹은 예외적으로 포함시키면, 당연히 다른 피부부속기관도 포함시켜야 하는 모순관계가 도출되는 문제가 있다고 사료된다. 반면 완전히 배제시키려면, (1) '흉복부'를 '흉복강'으로 하거나, (2) "유방은 제외된다"라는 단서 조항만 삽입하면 될 것이라고 생각해 본다. 법 앞에 만인이 평등하다 하지만 만인 앞에 법이 평등하기 위해서는, 즉 새로운 해석과 판결을 위해서는 사회적인 합의가 있어야 할 것으로 생각된다. Breast tissue is composed of skin, mammary gland(including lactiferous duct), subcutaneous fat layer. The anatomical position is on the anterior chest wall(the outside of the chest cavity) but not on the inside of the thorax. Therefore, when the internal organs in the thoracic cavity are defined and expressed as 'organs' and the internal organs of each are labeled for a long time, for the breast located outside the thoracic cavity, it is thought that there is considerable difficulty in defining and recognizing the breast tissue as organs. For this reason, it is necessary to discourage the controversy over whether or not the breast is contained in the chest(or intra-thoracic cavity). In order to completely exclude it, it is assumed that the "chest-abdomen" can be called the "intra-thoraxic or intra-abdominal." But it is difficult to change the terms in various laws and regulations, I think that it would be necessary to insert only the clue clause "Breasts are excluded" in the detailed criteria for grading. In order to include it, it is necessary to change the terms of the ordinance or to say that the breast is exceptionally included.

800MHz 대역 CDMA 기지국 무선부 설계 파라미터

강상기(Sang-Gee Kang),김봉겸(Bong-Kyum Kim),유기석(Ki-Suk Yoo) 한국정보과학회 1997 한국정보과학회 학술발표논문집 Vol.1997 No.4

다중경로 페이딩 환경에서 위상 에러를 갖는 광대역 DS-SS 시스템의 성능

이민주(Min-Ju Lee),김봉겸(Bong-Kyum Kim),김남수(Nam-Soo Kim) 한국통신학회 1999 한국통신학회 학술대회논문집 Vol.1999 No.7

[고주파 회로] 광대역 디지털 변조 신호용 전력 증폭기 ACPR 특성 해석

박현섭(Hyun Sup Park),이상학(Sang Hak Lee),구경헌(Kyung Heon Koo),김봉겸(Bong Kyum Kim),박재홍(Jae Hong Park) 한국통신학회 1997 한국통신학회 학술대회논문집 Vol.1997 No.11

피부이식과 피부판을 이용한 비결손 치험례

梁淳在,方裕鉉,朴鍾燮,金鳳謙 大韓成形外科學會 1982 Archives of Plastic Surgery Vol.9 No.2

The nose is the most prominent visible and central feature of the human face. Its size, shape, and configuration, therefore, play a significant role in the determination of man's appearance. Real or imaged deformity of the nose is highly significant in the individual's conception of his own self image. The nose is also a highly developed, complex and functional, organ. Its highly specialized nerves. lining membranes, delicate mobile cartilages, intrinsic muscles, and specialized vibrissage are essential for normal olfaction, taste, and the filterning, humidifiaction, and temperature regulation of inspired air. Practically, surgical reconstruction of the nose is limited to the maintenance of an adequate air passage into the nasopharynx and the replacement of lining, support, and covering tissue by various flaps and grafts. We have utilized skin graft, Brachial flap, and forehead flap to repair various types of defects of the nose.

국소침 윤마취시 Epinephrine 효과에 대한 관찰

金鳳謙,金容培,方裕鉉,朴種燮,柳在德 大韓成形外科學會 1983 Archives of Plastic Surgery Vol.10 No.1

The local anesthetics play a central and frundamental role, for they comprise, probably, the single most widely used group of durgs in the field of plastic surgery. Also many plastic surgical procedures require the use of a vasoconstrictor to reduce operative bleeding under both general and local anesthesia. Among local anesthetics, lidocaine, introduced by Lofgren in 1948, is one of most widely used local anesthetics and most frequently used for infiltration anesthesia with 0.5% to 1 0%solution. Also eqinephrine is one of the most potent and most useful vasoconstrictors for admixture with thesolution of local anesthetics for infiltration of tissue. In the clinical practice, it has been said that the concentration of lidocaine and epinephrine should be kept at the minimal level of effectiveness because of the epinephrine performs a dual service when is combined with lidocaine. In order to clarify the minimum concentration of the lidocaine and epinephrine respectively necessary for adequate duration of anesthesia, with less irritation of local tissue and less bleeding, the clinical observation and animal experiment were undertaken, and the following results were summarized. The most effective skin blanching by epinephrine was obtained with epinephrine concentration of 1 : 50,000 although some effect was still presented with epinephrine concentration of 1 : 800,000. The onset of maximum skin blanching following the local infiltration of lidocaine with epinephrine(1 : 50,000 to 1 : 400,000) was within 5 minutes and was lasting 20 to 40 minutes. When the skin incision was made 5 minutes to 15 minutes following local infiltration of epinephrine, the amount of bleeding was markedly decreased and no significant difference in the time of hemostasis was noticed(p〉0.1). Also no significant difference in the time of hemostasis was noticed in the different concentration (1 : 100,000 and 1 : 200,000) of epinephrine(p〉0.1). The optimum concentration of epinephrine is between 1 : 200,00 to 1 : 400,000 solution and the optimum concentration of lidocaine is 0.5%.

안면골 골절에 대한 임상 및 통계학적 고찰

김봉겸,양순재,고양실,방유현,박종섭 大韓成形外科學會 1981 Archives of Plastic Surgery Vol.8 No.2

It is the purpose of this study to provide a retrospective statistical analysis of facial bone fractures and to report some demographical information gathered from the patient's medical records. The medical records of 248 patients who received facial bone fractures (381 fractures) during a period July 1974 to June 1981 were reviewed and analyzed to gather statistics related to the Dime distribution, age, sex, causes, incidence of fracture, associated injuries, treatment, and complications. 1) An increase of facial fractures of 22.2% per year was noted. Septmber and July (12.5%, 12.1%) were months associated with the highest fracture rates, conciding with the vacation and holiday seasons. February (2.8%) was the lowest rates. The greatest number of patients were sustained by 46.4% in the highest rates between 6:00 PM. and the midnight. 2) The extremes of age in the study range from 4 year to 66 years with a mean 31.6 years. Predictably, most of the fractures occured in young males with the highest incidence in the 20 to 30 year age group(35.5%, 23.0%). Males predominated more than females, 3.2:1. 3) The moving vehicle accidents (65.3%) were responsible for the majority of trauma; the interpersonal violence (16.2%) was the next most common cause. 4) The facial bone fractures were classified in six categories : Nose, Orbit, Zygoma, Maxilla, Mandible and Alveolus with Teeth. The mandible(31.2%) was the most frequently involved area and the next frequent fracture site was the nasal complex(24.1%). The symphysis (43.3%) was the most common site in the mandibular fractures. Also the results indicate a significant incidence of single (58.8%) rather than multiple bone involvement. 5) Facial lacerations were sustained by 52.8% in the highest rates associated with the associated injuries. The chest (33.1%) was the most frequently involved area among the patients received orthopedic fractures. Surprisingly, cervical spine fractures were not noted. The cerebral contussion and concussion (28.6%) were in the highest rates associated with the life- threatening injuries. 6) The proper management of facial bone fractures include : 1. Non-immobilization (No-treatment or Conservative treatment), 45.9%; 2. Closed reduction, with interosseous fixation, usually with intermaxillary fixation as well, 29.4% ; 4 Combinated treatment,0.3%. 7) The infection on the operative sites & post-traumatic psychosis associated with complications were occured in the highest rates(each other 16.9%).

이차성 구순열 및 비부 변형과 그 교정

고양실,김봉겸,방유현,박종섭 大韓成形外科學會 1983 Archives of Plastic Surgery Vol.10 No.1

The correction of secondry cleft lips and nasal deformities often presents an extremely difficult plastic surgical problems. During the past century, the primary repair of cleft lips has received much considerations and there has been outstanding development in this field. However, the majority of these patients require correction later of secondary labial and nasal deformities of varing severity. Many factors are employed to secondary deformity, improper surgical method and skill, excessive trauma to the tissue and post-operative inflammation, other inadequate post-operative care or the hypertrophic scar, are included. With the patient's growing and development, underdevelopment of the maxilla is progressed and it accentuate the cleft lip and nasal defomities. Deformities commonly seen are irregular mucontaneous border, lateral poucking, notching of the lip border and flaring, flattening and asymmetry of the nostril with or without hypoplasia of the maxilla, and distortion due to hypertrophic scars and inert scar. Satisfactory function cannot be achieved and satisfaction cannot be achieved and satisfactory appearance cannot be formed and maintained without correct anatomical reconstruction of the involved parts. Disfigurement caused by all these secondary deformities tend to produce considerable embarrassement, profound psychic disturbances and socioeconomic problems. Thus, the correction of the secondary cleft lip and nasal deformities make the plastic surgeon endeaver to study. We experienced 53 cases of various secondry deformities with correction with varing method. Gennerally, cosmetic and functional improvement is obtainable in these cases satisfactorily. So, We introduces them with literature reports.