도금사업장의 작업환경의 유해인자 노출수준에 관한 연구

문덕환,도수영,이채관,황용식,선병관,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : For the purpose of preparing the fundamental data and assessing the status of exposure level of chemical substances and physical agents. Methods and Material : Such as noise, two types of dust, four types of metals, seventeen types of organic solvents, and four types of other materials classified by specific chemical substances in 21 metal product plating factories classified by 28 processes. The author determined exposure level on those hazardous materials from Jan. to Dec. 2001. Results : The results were as follows: 1. The exposure level for noise was exceeded to Threshold Limit Value(TLV) in the process of 6 cases of Machining, 5 and 4 cases of pre and post-buffing, and 6 cases of waterdrop-removing, the mean noise level of all of processes was not exceeded to compliance level. 2. The exposure level for dust was not exceeded to TLV at all. 3. The exposure level for Chromium(Cr) was exceeded to TLV in Chromium plating process, metal exposure level including Zinc(Zn), Manganese(Mn), and Lead(Pb) was not exceeded to TLV. 4. The exposure level of toluene in case of organic solvents was exceeded to TLV in 1 case of finishing/cleaning, coating/developing process, respectively. 5. The exposure level of four types of other materials classified by specific chemical substances were not exceeded to TLV. 6. The exposure level for dust and metal including Zn, Mn, and Pb was decreased in comparison with two results of air monitoring performed. There was no difference of the exposure level for Cr, noise, and four types of other materials classified by specific chemical substances, and the exposure level for organic solvents was slightly increased. 7. The exposure level for noise in factories employing more than 21 workers was higher than that for noise in foadtories employing less than 20 workers. The more workers, the lower exposure level in metal including Zn, Mn. The exposure level for Cr was increasing in factories employing more than 51 workers, and the more workers the lower exposure level in organic solvents. Conclusion : According to above results, this study suggests positive work environment managements in processes exceeding exposure limit value as well as continuously consecutive work environment management in processes not exceeding exposure limit value and revealing no chronological difference of exposure level should be needed.

산업보건에서도 정도보증제를 도입하자

문덕환,Mun, Deok-Hwan 대한산업보건협회 2006 산업보건 Vol.220 No.-

대동맥궁 대동맥류에서 Hybrid 수술적 치료

문덕환,김희중,정철현 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.4

Aortic arch aneurysm generally requires an urgent treatment due to the risk of catastrophic aortic rupture. However, conventional surgery for aortic arch repair still carries significant risks of postoperative morbidity and mortality, especially in patients with old age. In an effort to correct the aortic pathology while minimizing the risks of complications, we performed a hybrid technique which comprises the off pump arch vessels debranching and endocascular aortic stent grafting in an 86-old male patient with an aortic arch aneurysm. 대동맥궁 대동맥류는 파열의 위험성으로 인해 적극적이며 응급에 준하는 치료가 필요하다. 그러나, 전통적인 방법의 대동맥궁 치환술은 나이가 많거나, 여러 질환이 동반된 경우 수술 후 생길 수 있는 위험 및 합병증이 높아 수술을 쉽게 시행하기 어렵다. 저자들은 대동맥궁 대동맥류를 가진 86세 남자 환자에게 일반적인 수술이 아닌 Hybrid 수술(심폐기를 사용하지 않은, 혈관 내 스텐트 그라프트 삽입술 및 탈분지 혈관 연결)을 시행하여 성공하였기에 문헌고찰과 함께 보고하는 바이다.

조선업 종사 용접공들의 망간 흄 폭로 정도와 건강 위해

문덕환,박용만,이채언,박명희,박수경,김정호,이용희,황용식 인제대학교 1998 仁濟醫學 Vol.19 No.2

1997년 5월 1일부터 3개월간 부산지역 모 조선소에서 용접작업을 하는 근로자 120명을 폭로군으로 하고 동일 업체 타 부서에서 근무하며 용접 경력이 전혀 없는 근로자 69명을 대조군으로 하여 이들의 혈중 및 뇨중 망간의 농도를 산정하고 이학적 검사, 임상 증상에 대한 설문조사 및 임상 검사를 실시하였다. 이들 결과를 이용하여 조선업종에 종사하는 용접 공들의 망간 폭로 정도와 이로 인한 건강 위해 정도를 파악함으로써 향후 이들 작업장에서 망간폭로를 미연에 예방할 뿐아니라 향후 이들 분야 종사자들의 건강증진 대책을 마련함에 있어 기초자료를 제공하고자 한다. In order to evaluate the degree of manganese exposure and its heath hazards effect on welders in shipbuilding manufacturing industry, the author measured blood and urine concentrations of manganese and blood chemistry, and also observed clinical symptoms and signs on 120 welders for case and 69 non-welders for control working in shipbuilding manufacturing industry from May to July, 1997. The obtained results were as follows : 1.The mean values of blood and urine concentrations of manganese were 3.1±0.5㎍/dl and 2.6±1.1㎍/l for exposed group, 1.2±0.4㎍/dl and 1.4±0.7㎍/l for control group, and there was statistically significant difference between exposure and control group (P<0.05). 2.Symptoms in exposed group were fatigue(62.5%), excessive sweating (56.7%), amnesia(56.7%), nervousness(54.2%), arthralgia(50.0%), headache and weakness(49.2%) and so on, and there was statistically significant difference compared to control group (P<0.05). 3.Clinical signs in exposed group were tremor(21.7%), palmomental reflex(13.3%), grabellar sign(1.7% ), rigidity(0.8%) and arm swing(0.8%). 4.Manganese exposure effect on blood chemistry, liver function and grip-strength were not observed. 5.There was not statistically significant correlation between manganese concentration in blood, urine and laboratory findings include blood chemistry, liver function and so on. As abode results. the author suggest that further studies are followed to evaluate the status of welders whose blood and urine manganese concentrations were below normal reference level, and to establish the questionnaire and the diagnostic tools to detect the cronic manganese poisioning welders early.

AESOP을 이용한 좌측 최소개흉술하 동맥하형 심실중격 결손증 교정술 −1예 보고−

문덕환,이재원,조현진,제형곤,정성호,주석중,정철현,송현 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.5

Minimally invasive cardiac surgery using AESOP (Automated Endoscope System for Optimal Positioning) offers certain advantages such as better a cosmetic outcome, a shortened post operative recovery time and a shorten hospital stay, and these advantages are not achieved by conventional cardiac surgery. We report here on our first robot-assisted (AESOP) left minithoracotomy surgery in a 26 year-old female with a subarteral ventricular septal defect, and this might have been treated by median sternotomy before the development of AESOP.

조직판막을 이용한 대동맥판막치환술의 중기성적

문덕환,이재원,김윤석,조원철,정성호,주석중,정철현 대한흉부외과학회 2010 Journal of Chest Surgery (J Chest Surg) Vol.43 No.6

Background: The durability of the tissue valve is important in choice between a mechanical valve and a tissue valve in cardiac surgery. We studied the mid-term results of tissue valve in the aortic position. Material and Method: The subjects were 380 patients who had undergone aortic prosthesis replacement between May 1990 and March 2009. We retrospectively analyzed hospital and outpatient records: the mean age was 69±9 years; the male to female ratio was 227:162; and the mean follow-up duration was 46.7±40.8 months (range 0∼196 months). Result: 389 surgical cases in total had been taken with 380 patients. Early death occurred in 15 patients (3.9%). Overall survival rate at 1, 5 and 10 years were 92.3%, 78.1% and 54.2% respectively. Freedom from reoperation at 1, 5 and 10 years were 98.4%, 97.1% and 91.7% respectively. Freedom from structural valvular deterioration at 1, 5 and 10 years were 96.1%, 92.3% and 88.0% respectively. In the multivariate analysis of preoperative risk factors, young age (p<0.001) was significant risk factor for reoperation. High peak velocity in the postoperative period (p=0.034) and young age (p=0.029) were significant risk factors for structural valvular deterioration. Old age (p=0.001), long bypass time (p=0.035), concomitant coronary artery bypass graft surgery (p=0.003) and preoperative low left ventricular ejection fraction (p=0.003) were significant factors for early mortality. Preoperative estimated glomerular filtration rate (<60 mL/min) (p=0.025) and persistent left ventricular hypertrophy (p=0.032) were the risk factors for late mortality. Conclusion: This study showed that the freedom from reoperation and the freedom from structural valvular deterioration in aortic tissue valve replacement were acceptable. It will be necessary to conduct further studies with long-term follow-up and more patients. 배경: 조직판막의 내구성은 심장 판막 수술에서 기계판막과 조직판막을 선택하는 중요한 기준이 된다. 본 연구는 조직판막이 사용된 대동맥판막치환술의 중기성적을 분석해 보았다. 대상 및 방법: 이연구는 1990년 3월부터 2009년 3월까지 조직판막을 이용하여 대동맥판막치환술을 시행한 380명의환자들을 대상으로 하였다. 술 후 평균 관찰 기간은 46.7±40.8개월(0∼196개월)이었으며 외래 경과기록과 의무기록을 통하여 후향적으로 분석하였다. 결과: 총 380명의 환자에서 389예의 수술이 시행되었으며 환자들의 평균 연령은 69±9세, 남녀 비는 227:162였다 조기 사망은 15명(3.9%)이었다. 1년, 5년, 10년 생존율은 92.3%, 78.1%, 54.2%였다. 재수술의 1년, 5년, 10년 회피율(Freedom from reoperation)은 98.4%, 97.1%, 91.7%였으며 구조적 판막 손상 1년, 5년, 10년의 회피율(Freedom from structural valvular deterioration)은 96.1%, 92.3%, 88.0%였다. 수술 전 위험인자의 다변량 분석에서젊은 나이(p<0.001)가 재수술의 위험인자였으며 수술 후 판막 부하 최고속도(p=0.034)와 젊은 나이(p=0.029)가 구조적 판막 손상의 위험인자였다. 고령(p=0.001), 장시간의 심폐기사용(long bypass time) (p=0.035), 관상동맥 우회술을 동시에 실시한 경우(concomitant CABG) (p=0.003), 술 전 중등도이상의 좌심실 기능부전(Left ventricular ejection fraction, LVEF<40%) (p=0.003)이 조기 사망의 위험인자였으며 술 전 신기능저하(estimated glomerular filtration rate, eGFR<60 mL/min) (p=0.025)와지속적인 좌심실비대(persistent left ventricular hypertrophy, LVH) (p=0.032)가 만기 사망의 위험인자였다. 결론: 이 연구를 통해 조직판막을 이용한 대동맥판막치환술은 재수술과 구조적 판막 손상 회피율 등의 측면에서 만족할 만하다고 할 수 있으며, 향후 더 많은 환자에서 보다 장기적인 연구가 필요할 것으로 생각된다.

도시지역 건강한 성인 여성의 뇨증 중금속 농도에 관한 연구

문덕환,송인혁 인제대학교 1999 仁濟醫學 Vol.20 No.1

1994년 1월 27일부터 1994년 2월 6일 까지 서울, 부산, 천안, 함암의 4개 도시에 거주하는 20세 이상의 비흡연 건강한 성인 여성 143명을 대상으로 인체에 유해한 중금속을 Graphite furnance atomic absorption spectrophotometry로 정량하고 그 분포를 구하여 각 중금속의 정상치를 산정하여 중금속으로 인한 건강장해를 조기진단, 예방 및 관리를 하는데 도움을 주고자 본 조사를 실시하였으며 그 결과는 다음과 같다. 1.뇨중 중금속의 평균농도 1) Cr: 0.63±0.64㎍/ℓ 2) Cd: 1.68±1.50㎍/ℓ 3) Cu : 13.48±8.64㎍/ℓ 4) Mn : 7.33±8.78㎍/ℓ 5) Pb : 27.00±15.26㎍/ℓ 2.뇨중 중금속의 농도의 분포 1) Cr: 대수정규분포(왜도: -0.373, 첨도: -0.022, P>0.05) 2) Cd: 비정규분포(왜도: 1.202, 첨도: 0.579, P<0.05) 3) Cu: 대수정규분포(왜도: -0.016, 첨도: 0.301, P>0.05) 4) Mn: 비정규분포(왜도: 2.324, 첨도: 5.115, P<0.05) 5) Pb: 비정규분포(왜도: 0.671, 첨도: 0.541, P<0.05) 3.뇨중 크롬, 카드뮴, 구리, 망간, 연의 평균농도는 지역별로 유의한 차이가 있었으나(P<0.05), 연령별 차이는 없었다. 4.뇨중 구리와 뇨중 크롬이 뇨중 망간과 뇨중 카드뮴이 각각 정상관관계를 보였다(P<0.05, P<0.001). In order to provide basic data for early evaluation, prevention and management of health hazard caused by five heavy metals (chromium, cadmium, copper, manganese and lead), the author determined five heavy metals concentration in urine to 143 healthy matured nonsmoking females of 4 cities (Seoul, Pusan, Gheonan and Haman). The concentration of each heavy metal was measured by graphite furnace atomic absorption spectrometry. The urine sampling period was January 27 to February 6, 1994. The results were as follows. 1.The mean concentration of heavy metals in urine 1) Cr: 0.63±0.64㎍/ℓ 2) Cd: 1.68±1.50㎍/ℓ 3) Cu : 13.48±8.64㎍/ℓ 4) Mn : 7.33±8.78㎍/ℓ 5) Pb : 27.00±15.26㎍/ℓ 2.Tlle distribution of heavy metals concentration in urine 1) Cr : Lognormal distribution (Skewness : -0.373, Kurtosis : -0.022, P>0.05) 2) CD : Non-normal distribution (Skewness : 1.202, Kurtosis : 0.579, P<0.05) 3) Cu : Lognormal distribution (Skewness : -0.016, Kurtosis : 0.301, P>0.05) 4) Mn : Non-normal distribution (Skewness : 2.324, Kurtosis : 5.115, P<0.05) 5) Pb : Non-normal distributioon (Skewness : 0.671, Kurtosis : 0.541, P<0.05) 3.There were statistically significant differences in the concentrations in urine Cr, Cd, Cu, Mn and Pb by area(P<0.05). 4.Positive correlations were observed between correlations of Cr and Cu(P<0.001), Cu and Cr in urine(P<0.05). 5.The above results point out that the urinary heavy metals concentration of healthy adult women in urban area still hasn't reached the dangerous level. But if the degree of environmental pollution gets worse, the health hazard resulting from the overuse of heavy metal will increase. Therefore, more thoroughgoing measures to preserve our environment will be needed.

가스 크로마토그래피를 이용한 복합유기용제으 분리조건에 관한 연구

문덕환,이채언,김종갑,유영진,한용수,조규일,박헌인 인제대학교 1994 仁濟醫學 Vol.15 No.4

본 연구는 신발제조업, 페인트 제조업에서 주로 사용하는 23종(벤젠, 톨루엔 등)의 복합 유기용제를 대상으로 Gas Chromatography를 이용한 분리조건을 검정함으로써 산업 장에서의 작업환경을 보다 정확히 파악하게 할 뿐만 아니라 이를 취급하는 근로자들의 직업병 예방 뿐만 아니라 이들 분야의 기초자료를 얻고자 연구를 하였다. 가스 크로마토그래피를 이용하여 불꽃이온검출기(FID)로 검출온도 및 주입구의 온도를 변화시키면서 Capillary OV-1 컬럼을 이용한 가장 좋은 분리를 나타낸 조건은 컬럼온도가 35℃-150℃(6min Hold, 5℃/min) 조건으로 점진적인 변화를 시키면서 검출기 및 주입구의 온도가 250℃인 경우였으며, 압력은 0.41kg/cm2이었다. In order to described for the separate and the determination of concentration of 23 organic solvents (benzene, toluene, MEK, et al.) which is used extensively as solvents in the chemical industry, using gas chromatography(FID) with capillary column OV-1. The best analysis conditions were as follows : Gas Chromatography(GC) setting were the detector and the injector temperature 250℃. The temperature of column oven was initially 35℃, hold 6 min and then increased to 150℃ at 5℃/min. Inlet pressure of the carrier gas was 0.41kg/cm2.

부산지역 제조업 산업장의 작업공정별 소음수준의 경시적 변화(1996∼1998)

문덕환,문귀수,황용식,강동묵,이용희,박수경,이창희,이채언 인제대학교 2001 仁濟醫學 Vol.22 No.1

Objectives: This survey was conducted to provide the fundamental data on trends of noise level to improve of noisy working environment and to prevent of hearing loss in the manufacturing industry. Materials and Methods: The subject of this investigation was noise level of the 34 noisy processes among 92 manufactories of 9 industries in Pusan area. Study period was Jan. 1 1996 to Dec. 31 1998. Results: Geometric mean concentration and standard deviation for several manufactories were as follows. Food products and beverages, 78.1±1.16dB(A); manufactories of textiles. 82.2±1.04dB (A) ; tanning and dressing of leather (manufactories of luggage, handbag, saddlery, harness and footwear), 83.0±1.04dB (A) ; manufactories of wood and products, of wood and cork, except furniture, manufactories of articles of straw and plaiting materials. 93.3±1.02dB (A) ; manufactories of rubber and plastics products, 81.8±1.04dB(A) ; manufactories of basic metals, 86.4±1.06dB(A) ; manufactories of fabricated metal products, except machinery and equipment. 84.3±1.05dB (A) ; manufactories of machinery and equipment, not especially classified, 84.8±1.05dB(A) ; manufactories of furniture (manufacturing not especially classified) 84.9±1.03dB(A). Geometric mean concentration of noise in the 1st lumbering(92.9±1.02dB(A)) and the 2nd lumbering(93.8±1.02dB (A)) process of manufactories of wood and products of wood and cork, except furniture, sanding(92.4±1.04dB (A)) process of manufactories of basic metals industry were higher than the permissible noise exposures limit value. Conclusions: In the industrial hygienics aspect, special attention and management of working environment should be conducted for the manufacture of wood and products of wood and cork, except furniture, manufacture of articles of straw and plaiting materials and manufacture of basic metals industry in Pusan area.

도시와 농촌 비둘기 및 인체혈액중의 Vanadium 농도 산정에 관한 연구

문덕환,김준연,김정균 인제대학교 1985 仁濟論叢 Vol.1 No.1

This experiment determined the vanadium concentration in pigeon liver and lung tissues from rural and urban areas and .in bloods of workers (male 20, female 6) by carbon furnace Atomic Absorption spectrometry. The purpose of this experiment was in investigating the status of vanadium pollution in atmosphere. The summarized results were as follows : 1.The mean concentration of vanadium in pigeon liver and lung tissues from rural areas was 36.9±2.04ppb and 58.9±2.94ppb, respectively. 2.The mean concentration of vanadium in pigeon liver and lung tissues from urban areas was 64.0±2.62ppb and 91.7±4.26ppb, respectively. 3.The mean concentration of vanadium in pigeon liver and lung tissues from urban areas was more higher than that of rural (P〈0.05). 4.The mean concentration of vanadium in blood of workers(male 20, female 6) was 23.7±3.48ppb.