관상동맥 스텐트 시술 후의 재협착에 관한 연구

김윤철,이정우,김보영,강정아,임대승,이민수,김정희,성보영,최성준,성인환,전은석 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

Coronary stent implacement is known as an effective treatment in the intimal dissection after percutaneous transluminal coronary angioplasty and the prevention of restenosis. However, In-stent restenosis still remains a major concern in clinical stenting. The stents were placed in 103 patients from July 1996 to March 1999 and performed follow-up coronary angiograms in 59(57.3%) patients. To identify the clinical, angiographic and procedurerelated variables 'which predict late restenosis within the stented artery, 59 patients(58.3±9.9, M:F= 41:18) were studied. The clinical characteristics of the patients were stable angina in 23(39.0%), unstable angina in 14(23.7%), acute myocardial infarction in 21(35.6%) and old myocardial infarction in 1(1.7%). Coronary stenting was performed in 1 patient(1.7%) for primary lesion, 50 patients(84.7%) for suboptimal results after PTCA, 6 patients(10.2%) for bail-out procedure, and 2 patients(3.4%) for restenotic lesions. All patients were treated with aspirin and ticlopidinc. The follow-up angiograms were obtained at 7±4 months. The overall in-stent restenosis rate was 27.1%. The coronary angiographic findings were 32 single vessel(54.2%), 19 two vessel(32.2%) and 8 three vessel disease(13.6%). The angiographic morphological characteristics were type A in 33(55.9%), type B in 14(23.7%), type C in 12(20. 3%) cases. Variables of 16 patients with restenosis were compared with those of 43 patients without restenosis. Previously known predictors for in-stent restenosis were multiple stenting, stenting for restenotic lesions, residual stenosis after stenting, stenting for total occlusion lesions, reference diameter, balloon to vessel ratio, acute gain and minimal luminal diameter after procedure, design and characteristics of stents, ostial lesion of aorta, high pressure method for stenting, lesion length, diabetes mellitus, size of artheroma, saphenous vein grafts, ulcerlating lesions and calcified lesions. In this study, Reference diameter before stenting(2.43±0.54mm vs. 2.88±0.65mm, p=0.016) and balloon-to-artery ratio(1.28±0.26 vs. 1.11±0.18, p=0.006) were predictors for in-stent restenosis. 1) The overall in-stent restenosis rate was 27.1%. 2) In the analysis of predictors for in-stent restenosis, there was no significant differences in clinical, angiographic factors between group with restenosis and without restenosis. But, Only reference diameter before stenting and balloon-toartery ratio were predictors of late in-stent restenosis. In conclusion, stenting is effective revascularisation method for selected patients with ischemic heart disease, and to minimize in-stent restenosis rate, stent implanting is achieved in a large vessel on the basis of an artery-to-stnet ration of 1:1, if possible.

한 합금공장에서 집단 발생환 급성 베릴륨 질환

김현주,정우철,지영구,김대성,강성규,노상철,조규탁,김동현 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.1

목적: 같은 공장에서 일했던 노동자들 중 원인미상의 급성 폐장염 2례가 발견된 것을 계기로 한 합금공장에서 집단 발생한 화학적 폐장염의 원인을 규명하기 위하여 역학조사를 실시하였다. 방법: 연구대상은 한 합금공장에서 일했던 생산직 노동자 45명 전원이었다. 작업환경측정 기록을 검토하고 일반 폐기능검사,흉부방사선 촬영,작업종료후 요중 베릴륨 농도측정을 포함한 특수건강진단을 실시하였고,유증상자와 유소견자 11명에 대하여 이차로 고해상도 컴퓨터 단층 촬영 및 폐확산능 검사를 실시하였다. 결과: 베릴륨의 공기 중 농도를 평가한 결과 베릴륨이 O.42∼112.3 μg/m³이었고, 요중 베릴륨 농도는 용해 (O.53±0.79 μg/g. creatinine),금형(1.41±0.50 μg/g. creatinine),사상(1.16±0.53 μg/g. creatinine)순으로 높았으나 통계적으로 유의한 차이는 없었다. 일차 특수건강진단결과 용해공정은 비용해공정보다 현재 기침 (p=0.054), 호흡곤란(p= 0.030),입사이후 호흡기증상으로 인한 투약경험률(p=0.018)은 모두 용해작업자가 비용해공정보다 높았으며 일반 폐기능 검사결과는 두 군 간에 차이가 없었다. 최종적으로 화학성 폐장염으로 분류된 사람은 모두 11명으로 그 발생률은 용해공정에서 32.0%,비용해 공정에서 5.0%이었다(p=O.012). 2002년 12윌 이전 입사자에서 발생률은 33.3%이었고 그 이후 입사자에서는 환자가 발생하지 않았다(p<O.001). 결론: 급성 폐장염이 대부분이 용해공정에서 발생했고 모두 환기시설이 설치되기 전부터 작업했던 점으로 보아 이는 급성 베릴륨질환의 가능성이 매우 높다 이는 적절한 작업환경관리로 충분히 예방할 수 있는 질병이므로 앞으로 이러한 문제를 예방하기 위한 정책적 대안을 제시하였다. Objectives: We conducted an epidemiological survey to inquire into an outbreak of acute pneumonitis after two reported cases of interstitial lung disease. Methods: The study subjects were 45 workers from a compound metal alloy factory. We reviewed the factory's industrial hygiene data along with the results of a special health examination, including pulmonary function tests, simple chest X-rays, and high resolution computed tomography. Results: The air concentrations of beryllium ranged from 0.42 μg/m³ to 112.3 μg/m³, and the mean concentration of urinary beryllium were 1.53±0.79μg/g of creatinine in the molding workers, 1.41±0.50μg/g, of creatinine in the casting workers, and 1.16±0.53μg/g of creatinine in the sorting workers. The rates for cough (p=0.054), dyspnea (P=0.030), and the use of medical services (p=0.018) were higher in the molding workers than in the non-molding workers. The incidence rate of acute interstitial lung disease was higher for the molding process (32.0%) than for the non-molding process (5.0%) (P=0.012). The time of employment for all patients was prior to December 1^(st), 2002. Conclusions: Since most of the patients were molding workers, and all of the patients had worked without a ventilation system, this outbreak of acute interstitial lung disease was regarded as acute beryllium disease. Although the direct cause of the epidemic was the beryllium fumes, the fundamental cause was improper control of the work environment. Therefore, the means for preventing avoidable epidemics of occupational diseases are discussed.

Kim,Seong-soo : Possiblity of Low Salting Process in Gae-Woo Jeot(Salted and Fermented Gastrophoda) and Changes in Fatty Acid Composition during Fermntation 低鹽化 可能性 檢討 및 熱成중 脂肪酸 組成의 變化

姜永周,河璡桓,金永東,宋大鎭,金洙賢,金成洙 제주대학교 1990 논문집 Vol.30 No.-

To establish the way of processing of Gae-Woo jeot which used abalone intestine that has not been systematically used compare to its characteristic taste and fame as main ingredient and to develop as a local tourist good, the change of constituents the quality of salted fish products suring Gae-Woo jeot fermentation were examined. The results are as follows. 1. In the organoleptic test, Gae-Woo jeot which fermented through 65 days were dominant and the group of 105 salkt concentration were better than that of 20%. It was the best of 10% salted products to add small abalone. Both law salted(10%) and high salted (20%) Gae-Woo jeot were similar in general constityents, nutrients and texture. 2. Compositions of highly unsaturated acid were farely high to 45.6% and 46.1% in small abalone added froup and top sheel added group respectively. during 3 months fermentation low decreasing rate of 3~4% was shown. EPA(eicosapentaenoic acid) was approximately 7~8% and DHA(docosahexaenoic acid) was extremely low to be less than 0.3%. 3. In the changes General composition and pH, pH was within range of 4~5.5, 9~12% in protein, 3~5% in total sugar, 0.5~1% in lipid and approximately 1% in ash. 4. Gae-Woo jeot can be made with 10% low salting method, and 10% group gets all the better for taste, small abalone adding is recommended. 5. When low salt fermented fish of 10% is processed, it is highly recommended to put sorbitol, ethyl alcohol, lactic acid or other humectant for better taste and longer storage and good quality food additives must be developed for tourist and presently applied mil ordering transportation must be sought.

생체분해성 망막압정을 이용한 망막고정에 대한 실험적 연구

김용백,민병무,김창식,박근성,김승영,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Biodegradable retinal fixation devices obtain mechnical fixation of the retina with desirable chorioretinal scarring and with the potential for local, sustained release of antimetabolites and steroids to inhibit proliferative vitreoretinopathy. We manufactured a biodegradable retinal tack with barb that was designed in order to prevent intrusion from implantation of retinal tacks. This study was carried to evaluate the efficacy for retinal fixation and the capability for sustained release of drugs with a newly designed biodegradable retinal tack Biodegradable retinal tacks were made of polymers of glycolic acids and were designed with barbs in a shape to prevent the disinsertion. Biodegradale retinal tacks are divided into 3 parts, a conical portion that is inserted into the sclera, a cylinder portion that remains in the vitreous, and a neck portion between the pin and the cylinder. The tapered conical end was manufactured to allow easy insertion through the retina and choroid into the sclera. A cylinder portion was manufactured with a tapered angle that fixes firmly into the orifice of 19 gauge spinal needle. A neck portion, 0.4 mm in diameter, was designed to prevent disinsertion from following implantation of retinal tack. The applicator was a 19 gauge spinal needle and its orifice was prepared to 15°angle to accept the tapered cylinder portion of the retinal tack. The retinal tacks, secured in the needles, were passed through the formed vitreous and inserted into the retina, choroid, and sclera and were released by pushing the internal needle, usually within 2-3mm of the medullary ray of the posterior rabbit retina A retinal tack was placed in each of 8 pigmented rabbit eyes. Slit-lamp biomicroscopy, indirect ophthalmoscopy and fundus photography were performed periodically from 1 day to 8 weeks after surgery. Eight eyes were enucleated and studied by light microscopy at 8 weeks. Biomicroscopic evaluation of the animals revealed edemas adjacent to the retinal surfaces immediately after insertion of the biodegradable retinal tacks in all the animals. These edemas disappeared after 1 week. The first noticeable change in the size of retinal tacks was shown after 2weeks. The size of the retinal tacks gradually got smaller, decreasing to about one-half at 4 weeks and about one-third at 8 weeks. All retinal tacks remained in inserted places without any movement for an 8 week period. On light microscopy, epiretinal proliferations were seen to extend into the vitreous cavity. Cellular capsules that lined the inner aspect of the scleral defect caused by tack insertion were found. However the adjacent retina had a normal cytologic appearance and architecture in all specimens. We manufactured a biodegradable retinal tack that is designed to prevent intrusion from implantation of retinal tacks. All biodegradable retinal tacks reduce in size with time, but no retinal tacks extruded from the inserted place. The newly designed biodegradable retinal tack can be used for retinal fixation and may be used as a vehicle for the introduction of pharmacologic agents to prevent the cellular events that promote proliferative vitreoretinopathy.

관상동맥질환을 동반한 모야모야병 1례

김동기,이영태,김기향,김성만,김대경,김두일,김동수 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Moyamoya disease is an occlusive intracranial arteriopathy with an abnormal cerebral vascular collateral networks. Although this disease is known to be associated with stenosis of extracranial arteries, such as the renal artery, a case associated with stenosis of the coronary artery is extremely rare. We report a case of coronary artery occlusive disease affected by Moyamoya disease. The patient was a 38-year-old female experiencing intermittent headache and exer tional chest pain. Cerebral MRI showed complete obstruction of both internal carotid arteries and abnormal cerebrovascular systems which confirmed Moyamoya disease. Coronary angiography showed a significant stenosis of left anterior descending coronary artery ostium with TIMI grade I collateral blood flow from the normal right coronary artery. After coronary artery stenting and medical treatment for headache, her subjective symptoms were relieved. In Moyamoya patient, an evaluation of the extracranial (especially coronary artery) vascular system should be considered if there are some evidences of coronary artery disease.

Clinical Outcome of Modified Cervical Lateral Mass Screw Fixation Technique

Kim, Seong-Hwan,Seo, Won-Deog,Kim, Ki-Hong,Yeo, Hyung-Tae,Choi, Gi-Hwan,Kim, Dae-Hyun The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.2

Objective : The purpose of this study was 1) to analyze clinically-executed cervical lateral mass screw fixation by the Kim's technique as suggested in the previous morphometric and cadaveric study and 2) to examine various complications and bicortical purchase that are important for b-one fusion. Methods : A retrospective study was done on the charts, operative records, radiographs, and clinical follow up of thirty-nine patients. One hundred and seventy-eight lateral mass screws were analyzed. The spinal nerve injury, violation of the facet joint, vertebral artery injury, and the bicortical purchases were examined at each lateral mass. Results : All thirty-nine patients received instrumentations with poly axial screws and rod systems, in which one hundred and seventy-eight screws in total. No vertebral artery injury or nerve root injury were observed. Sixteen facet joint violations were observed (9.0%). Bicortical purchases were achieved on one hundred and fifty-six (87.6%). Bone fusion was achieved in all patients. Conclusion : The advantages of the Kim's technique are that it is performed by using given anatomical structures and that the complication rate is as low as those of other known techniques. The Kim's technique can be performed easily and safely without fluoroscopic assistance for the treatment of many cervical diseases.

직업적 노출에 의한 스티븐스-존슨 증후군에서 트리클로로에틸렌의 노출수준 : 3예의 사례와 문헌고찰을 중심으로

이선웅,김은아,김대성,고동희,강성규,김병규,김민기 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.2

배경: TCE는 심각한 전산적 피부염과 관련 있는 것으로 몇몇 사례들을 통해서 보고되어 왔으나,기존의 사례 보고들에서 노출평가가 수행된 사례는 드물었고 추정되는 노출량 역시 매우 다양하였다. 본 연구에서는 TCE 노출에 의한 것으로 판단되는 스티븐스-존슨 증후군 3예를 확인하고 각 사례들에 대한 작업재연을 통해 노출수준을 추정하였으며,이를 통해 TCE의 직업적 노출수준과 스티븐스-존슨 증후군을 포함하는 전신적 박탈성 피부염 발생의 관계를 이해하고자 하였다. 증례: 사례 1은 24세 필리핀인 여자로 TCE를 이용한 탈지작업을 시작한 35일 후 발진을 포함한 피부증상이 발생하였고 증상이 진행되면서 간기능 이상이 발견되었다. 환자는 스티븐스 존슨 증후군과 독성간염으로 진단되었고 증상발생 39일 간부전으로 사망하였다. 증상발생 전 약물 복용력은 없었고 바이러스 감염 등의 비직업적 원인은 찾을 수 없었으며,작업재연을 통한 TCE의 개인 노출수준 은 TWA 21.9 ppm과 32.3 ppm이었다. 사례 2는 47세 한국인 남자로 TCE를 이용한 탈지 작업을 시작한 20일 후 발진을 포함한 피부증상이 발생하였고 증상이 진행되면서 간기능 이상이 발견되었다. 환자는 중독성 표피괴사증 또는 스티븐스 -존슨 증후군, 전격성간염 및 동반된 패혈증으로 진단되었고 증상발생 42일 간부전 및 패혈증으로 사망하였다. 증상발생 전 약물복용력은 없었고 바이러스 감염 등의 비직업적 원인은 찾을 수 없었으며,작업재연을 통한 TCE의 개인 노출수준은 TWA 30.1 ppm이었으며 세척조 주위의 지역시료는 TWA 116.5 ppm∼229. 7 ppm 이었다. 사례 3은 22세 베트남인 여자로 TCE를 이용한 탐지작업을 시작한 30일 후 발전을 포함한 피부증상이 발생하였고 증상이 진행되면서 간기능 이상이 발견되었다. 환자는 스티븐스-존슨 증후군 및 동반된 독성간염으로 진단되었고 증상발생 37일 증세 호전되어 퇴원하였다. 증상발생전 약물복용력은 없었고 바이러스 감염 등의 비직업적 원인은 찾을 수 없었으며,작업재연을 통한 TCE의 개인 노출수준은 TWA 107.2 ppm이었다. 고찰: TCE에 노출된 일부의 사람들에서 노출 후 2주에서 5주 사이에 심각한 급성 간염이 동반되는 스티븐스­존슨 증후군이 발생할 수 있음을 확인 하였고,이번의 연구결과와 기존의 연구를 종합 할 때 TCE에 대한 감수성이 있는 사람의 상당수는 노출기준 이상의 고 노출에 노 출 후 스티븐스- 존슨 증후군이 발생함을 확인할 수 있었다. 따라서. TCE에 대한 고 노출을 막기 위해 TCE 세척작업에 대한 작업환경 확인과 개선이 우선적으로 필요하며,동시에 노출 후 증상발생기간의 일관성과 노출기준 이하의 저 노출에서의 감작 가능성을 배제할 수 없음을 고려하여,작업시작 후 1개월경의 특수건강검진 역시 고려되어야 할 것으로 판단된다. Back ground: Trichloroethylene (TCE) has been reported to be related to severe generalized exfoliative dermatitis frequently accompanied by toxic hepatitis. The measurements of environmental exposure were limited in the previous case reports and the reported exposure values were also diverse. We reviewed three cases of Stevens-Johnson syndrome associated with TCE. The work environment was measured by the Korea Occupational Safety and Health Agency (KOSHA) after the cases occurred. From the study results, we intended to clarify the relationship between TCE exposure level and Stevens-Johnson syndrome. Case report: Case 1. A 24-year-o1d Filipino female worker developed a skin rash 35 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. She died of hepatic failure 39 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 22.0 to 32.3 ppm (Personal exposure level) with TWA. Case 2. A 47-year-o1d Korean male worker developed a skin rash, 20 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. He was diagnosed with Stevens-Johnson syndrome, toxic hepatitis and sepsis. He died of hepatic failure and sepsis 42 days after the onset ofthe first symptom. He had no previous history of taking medicine or viral infection. The work environment measured 30.1 ppm (Personal exposure level) and 116.5∼229.7 ppm (area exposure level close to the degreasing rnachine) with TWA. Case 3. A 22-year-old Vietnamese female worker developed a skin rash 30 days after starting to use TCE for degreasing. The skin rash developed into a bullous eruption and the liver function findings were abnormal. She was diagnosed with Stevens-Johnson syndrome and toxic hepatitis. Her symptoms improved and she was discharged 37 days after the onset of the first symptom. She had no previous history of taking medicine or viral infection. The work environment measured 107.2 ppm (Personal exposure level) with TWA. Discussion: These three case reports and the previously reported cases indicated that the majority of people susceptible to TCE develops Stevens-Johnson syndrome after high-level TCE exposure (above the TWA occupational exposure limit of 50 ppm). Therefore, work environmental survey and improvements to the TCE degreasing process are essential to prevent high exposure. Furthermore, considering the consistency of the latency period in symptoms and the possibility of sensitization in low-level exposure, we recommend that the first specific health examination also should be conducted 1 month after workers have commenced working.

주폐자충 폐렴으로 발현된 Felty 증후군 1예

김성호,남대근,문재현,김지홍,김보석,안진광,문태건,안병재,김성일 全南大醫大 2001 전남의대학술지 Vol.37 No.3

8년간(1992~1999) 산업안전보건연구원에 의뢰된 직업병 심의 사례 분석

강성규,김규상,김양호,최정근,안연순,진영우,최병순,양정선,김은아,채창호,최용휴,김대성,박정선,정호근 대한산업의학회 2000 대한직업환경의학회지 Vol.12 No.2

Objectives : Pneumoconisis and noise-induced hearing loss (NIHL) have been reported as main occupational diseases by the Special Health Examination. The Industrial Accident Compensation Insurance has reported various work-related diseases, however, these two diseases occupied almost a half of compensated cases. Therefore, it was not well known about the status of occupational diseases other than pneumoconiosis, NIHL, and cardio-cerebrovascular accident (CVA). This study was conducted to analyze claimed cases as an occupational disease, that was requested to the Korea Industrial Safety and Health Agency (KOSHA). Methods : The local office of the Korea Labor Welfare Corporation (KLWC) has asked the KOSHA for confirmation of claimed cases as an occupational disease. We analyzed 379 cases requested from KLWC, the Ministry of Labor, employers, unions and occupational health agencies from 1992 to 1999. Results : Male was 80.7 % of the requested cases. Their mean age was 42 years old and 75.5 % of them were more than 35 years old. The requested cases were increased rapidly from 25 cases in 1992 to 108 cases in 1999 and the accept rate was 50.7 %. The majority of requested cases were respiratory diseases(22.4%), cancers(18.5%), Neuropsychiatric problems(14.5%), and musculoskeletal problems(13.5%). The accept rate was high in reproductive, respiratory, musculoskeletal and digestive disorders and low in neuropsychiatric, renal and otologic problems and occupational cancers. 73.6% of them were caused by chemical agents, especially 28.5 % were by organic solvents. 67% of them were clinically confirmed at university hospitals. A half of the cases were from KyongIn area, even the request came from the whole country. Conclusions : A claim was common in workers whose age was over 35 years old and exposure history was over 10 years. The respiratory diseases and neuropsychiatric disorders were still main problems in occupational health and occupational cancers was increasing even though its accept rate was not high yet.

전국 단위 감시체계의 현황과 전망

강성규,안연순,지영구,김형옥,하미나,권호장,백남종,김성아,홍윤철,김재용,강대희,정혜선,하은희 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.2