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Immediate Reoperation for Failed Mitral Valve Repair (승모판막성형술 실패 직후에 시행한 재수술)

  • Baek, Man-Jong;Na, Chan-Young;Oh, Sam-Se;Kim, Woong-Han;Whang, Sung-Wook;Lee, Cheol;Chang, Yun-Hee;Jo, Won-Min;Kim, Jae-Hyun;Seo, Hong-Ju;Kim, Wook-Sung;Lee, Young-Tak;Park, Young-Kwan;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.36 no.12
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    • pp.929-936
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    • 2003
  • We analysed the surgical outcomes of immediate reoperations after mitral valve repair. Material and Method: Eighteen patients who underwent immediate reoperation for failed mitral valve repair from April 1995 through July 2001 were reviewed retrospectively. There were 13 female patients. The mitral valve disease was regurgitation (MR) in 12 patients, stenosis (MS) in 3, and mixed lesion in 3. The etiologies of the valve disease were rheumatic in 9 patients, degenerative in 8, and endocarditis in 1. The causes of reoperation was residual MR in 13 patients, residual MS in 4, and rupture of left ventricle in 1. Fourteen patients had rerepair for residual mitral lesions (77.8%) and four underwent replacement. Result: There was no early death. After mean follow-vp of 33 months, there was one late death. Echocardiography revealed no or grade 1 of MR (64.3%) in 9 patients and no or mild MS in 11 patients (78,6%). Reoperation was done in one patient. The cumulative survival and freedom from valve-related reoperation at 6 years were 94% and 90%, respectively. The cumulative freedom from recurrent MR and MS at 4 years were 56% and 44%, respectively. Conclusion: This study suggests that immediate reoperation for failed mitral valve repair offers good early and intermediate survival, and mitral valve rerepair can be successfully performed in most of patients. However, because mitral rerepair have high failure rate, especially in rheumatic valve disease, adequate selections of valvuloplasty technique and indication are important to reduce the failure rate of mitral rerepair.

Effects of Anti-thyroglobulin Antibody on the Measurement of Thyroglobulin : Differences Between Immunoradiometric Assay Kits Available (면역방사계수법을 이용한 Thyroglobulin 측정시 항 Thyroglobulin 항체의 존재가 미치는 영향: Thyroglobulin 측정 키트에 따른 차이)

  • Ahn, Byeong-Cheol;Seo, Ji-Hyeong;Bae, Jin-Ho;Jeong, Shin-Young;Yoo, Jeong-Soo;Jung, Jin-Hyang;Park, Ho-Yong;Kim, Jung-Guk;Ha, Sung-Woo;Sohn, Jin-Ho;Lee, In-Kyu;Lee, Jae-Tae;Kim, Bo-Wan
    • The Korean Journal of Nuclear Medicine
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    • v.39 no.4
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    • pp.252-256
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    • 2005
  • Purpose: Thyroglobulin (Tg) is a valuable and sensitive tool as a marker for diagnosis and follow-up for several thyroid disorders, especially, in the follow-up of patients with differentiated thyroid cancer (DTC). Often, clinical decisions rely entirely on the serum Tg concentration. But the Tg assay is one of the most challenging laboratory measurements to perform accurately owing to antithyroglobulin antibody (Anti-Tg). In this study, we have compared the degree of Anti-Tg effects on the measurement of Tg between availale Tg measuring kits. Materials and Methods: Measurement of Tg levels for standard Tg solution was performed with two different kits commercially available (A/B kits) using immunoradiometric assay technique either with absence or presence of three different concentrations of Anti-Tg. Measurement of Tg for patient's serum was also performed with the same kits. Patient's serum samples were prepared with mixtures of a serum containing high Tg levels and a serum containg high Anti-Tg concentrations. Results: In the measurements of standard Tg solution, presence of Anti-Tg resulted in falsely lower Tg level by both A and B kits. Degree of Tg underestimation by h kit was more prominent than B kit. The degree of underestimation by B kit was trivial therefore clinically insignificant, but statistically significant. Addition of Anti-Tg to patient serum resulted in falsely lower Tg levels with only A kit. Conclusion: Tg level could be underestimated in the presence of anti-Tg. Anti-Tg effect on Tg measurement was variable according to assay kit used. Therefore, accuracy test must be performed for individual Tg-assay kit.

Clinical Analysis of Repeated Heart Valve Replacement (심장판막치환술 후 재치환술에 관한 임상연구)

  • Kim, Hyuck;Nam, Seung-Hyuk;Kang, Jeong-Ho;Kim, Young-Hak;Lee, Chul-Burm;Chon, Soon-Ho;Shinn, Sung-Ho;Chung, Won-Sang
    • Journal of Chest Surgery
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    • v.40 no.12
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    • pp.817-824
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    • 2007
  • Background: There are two choices for heart valve replacement-the use of a tissue valve and the use of a mechanical valve. Using a tissue valve, additional surgery will be problematic due to valve degeneration. If the risk of additional surgery could be reduced, the tissue valve could be more widely used. Therefore, we analyzed the risk factors and mortality of patients undergoing repeated heart valve replacement and primary replacement. Material and Method: We analyzed 25 consecutive patients who underwent repeated heart valve replacement and 158 patients who underwent primary heart valve replacement among 239 patients that underwent heart vale replacement in out hospital from January 1995 to December 2004. Result: There were no differences in age, sex, and preoperative ejection fraction between the repeated valve replacement group of patients and the primary valve replacement group of patients. In the repeated valve replacement group, the previously used artificial valves were 3 mechanical valves and 23 tissue valves. One of these cases had simultaneous replacement of the tricuspid and aortic valve with tissue valves. The mean duration after a previous operation was 92 months for the use of a mechanical valve and 160 months for the use of a tissue valve. The mean cardiopulmonary bypass time and aortic cross clamp time were 152 minutes and 108 minutes, respectively, for the repeated valve replacement group of patients and 130 minutes and 89 minutes, respectively, for the primary valve replacement group of patients. These results were statistically significant. The use of an intra aortic balloon pump (IABP) was required for 2 cases (8%) in the repeated valve replacement group of patients and 6 cases (3.8%) in the primary valve replacement group of patients. An operative death occurred in one case (4%) in the repeated valve replacement group of patients and occurred in nine cases (5.1%) in the primary valve replacement group of patients. Among postoperative complications, the need for mechanical ventilation over 48 hours was different between the two groups. The mean follow up period after surgery was $6.5{\pm}3.2$ years. The 5-year survival of patients in the repeated valve replacement group was 74% and the 5-year survival of patients in the primary valve replacement group was 95%. Conclusion: The risk was slightly increased, but there was little difference in mortality between the repeated and primary heart valve replacement group of patients. Therefore, it is necessary to reconsider the issue of avoiding the use of a tissue valve due to the risk of additional surgery, and it is encouraged to use the tissue valve selectively, which has several advantages over the use of a mechanical valve. In the case of a repeated replacement, however, the mortality rate was high for a patient whose preoperative status was not poor. A proper as sessment of cardiac function and patient status is required after the primary valve replacement. Subsequently, a secondary replacement could then be considered.

Mid-Term Results of 292 cases of Coronary Artery Bypass Grafting (관상동맥 우회술 292례의 중기 성적)

  • 김태윤;김응중;이원용;지현근;신윤철;김건일
    • Journal of Chest Surgery
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    • v.35 no.9
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    • pp.643-652
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    • 2002
  • As the prevalence of coronay artery disease is increasing, the surgical treatment has been universalized and operative outcome has been improved. We analyzed the short and mid-term results of 292 CABGs performed in Kangdong Sacred Heart Hospital. Material and Method: From June 1994 to December 2001, 292 patients underwent coronary artery bypass grafting. There were 173 men and 119 women and their ages ranged from 39 to 84 years with a mean of $61.8{\pm}9.1$ years. We analyzed the preoperative risk factors, operative procedures and operative outcome. In addition, we analyzed the recurrence of symptoms, long-term mortality and complications via out-patient follow-up for discharged patients. Result: Preoperative clinical diagnoses were unstable angina in 137(46.9%), stable angina in 34(11.6%), acute myocardial infarction in 40(13.7%), non-Q myocardial infarction in 25(8.6%), postinfarction angina in 22(7.5%), cardiogenic shock in 30(10.3%) and PTCA failure in 4(1.4%) patients. Preoperative angiographic diagnoses were three-vessel disease in 157(53.8%), two-vessel disease in 35 (12.0%), one-vessel disease in 11(3.8%) and left main disease in 89(30.5%) patients. We used saphenous veins in 630, internal thoracic arteries in 257, radial arteries in 50, and right gastoepiploic arteries in 2 distal anastomoses. The mean number of distal anastomoses per patient was $3.2{\pm}1.0$ There were 18 concomitant procedures ; valve replacement in 8(2.7%), left main coronary artery angioplasty in 6(2.1%), patch closure of postinfarction ventricular septal defect(PMI-VSD) in 2(0.7%), replacement of ascending aorta in 1(0.3%) and coronary endarterectomy in 1(0.3%) patient. The mean ACC time was $96.6{\pm}35.3 $ minutes and the mean CPB time was $179.2{\pm}94.6$ minutes. Total early mortality was 8.6%, but it was 3.1% in elective operations. The most common cause of early mortality was low cardiac output syndrome in 6(2.1%) patients. The stastistically significant risk factors for early mortality were hypertension, old age($\geq$ 70 years), poor LV function(EF<40%), congestive heart failure, preoperative intraaortic balloon pump, emergency operation and chronic renal failure. The most common complication was arrhythmia in 52(17.8%) patients. The mean follow-up period was $39.0{\pm}27.0$ months. Most patients were free of symptoms during follow-up. Fourteen patients(5.8 %) had recurrent symptoms and 7 patients(2.9%) died during follow-up period. Follow-up coronary angiography was performed in 13 patients with recurrent symptoms and they were managed by surgical and medical treatment according to the coronary angiographic result. Conclusion: The operative and late results of CABG in our hospital, was acceptable. However, There should be more refinement in operative technique and postoperative management to improve the results.

In the Treatment I-131, the Significance of the Research that the Patient's Discharge Dose and Treatment Ward can Affect a Patient's Kidney Function on the Significance of Various Factors (I-131 치료시 환자의 신장기능과 다양한 요인으로 의한 퇴원선량 및 치료병실 오염도의 유의성에 관한 연구)

  • Im, Kwang Seok;Choi, Hak Gi;Lee, Gi Hyun
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.1
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    • pp.62-66
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    • 2013
  • Purpose: I-131 is a radioisotope widely used for thyroid gland treatments. The physical half life is 8.01 and characterized by emitting beta and gamma rays which is used in clinical practice for the purpose of acquiring treatment and images. In order to reduce the recurrence rate after surgery in high-risk thyroid cancer patients, the remaining thyroid tissue is either removed or the I-131 is used for treatment during relapse. In cases of using a high dosage of radioactive iodine requiring hospitalization, the patient is administered dosage in the hospital isolation ward over a certain period of time preventing I-131 exposure to others. By checking the radiation amount emitted from patients before discharge, the patients are discharged after checking whether they meet the legal standards (50 uSv/h). After patients are discharged from the hospital, the contamination level is checked in many parts of the ward before the next patients are hospitalized and when necessary, decontamination operations are performed. It is expected that there is exposure to radiation when measuring the ward contamination level and dose check emitted from patients at the time of discharge whereby the radiation exposure by health workers that come from the patients in this process is the main factor. This study analyzed the correlation between discharge dose of patients and ward contamination level through a variety of factors such as renal functions, gender, age, dosage, etc.). Materials and Method: The study was conducted on 151 patients who received high-dosage radioactive iodine treatment at Soon Chun Hyang University Hospital during the period between 8/1/2011~5/31/2012 (Male: Female: 31:120, $47.5{\pm}11.9$, average dosage of $138{\pm}22.4$ mCi). As various factors expected to influence the patient discharge dose & ward contamination such as the beds, floors, bathroom floors, and washbasins, the patient renal function (GFR), age, gender, dosage, and the correlation between the expected Tg & Tg-Tb expected to reflect the remaining tissue in patients were analyzed. Results: In terms of the discharge dose and GFR, a low correlation was shown in the patient discharge dose as the GFR was higher (p < 0.0001). When comparing the group with a dosage of over 150mCi and the group with a lower dosage, the lower dosage group showed a significantly lower discharge dose ($24{\pm}10.4uSv/h$ vs $28.7{\pm}11.8uSv/h$, p<0.05). Age, gender, Tg, Tg-Tb did not show a significant relationship with discharge dose (p> 0.05). The contamination level in each spot of the treatment ward showed no significant relationship with GFR, Tg, Tg-Tb, age, gender, and dosage (p>0.05 ). Conclusion: This study says that discharge of the dose in the patient's body is low in GFR higher and Dosage 150mCi under lower. There was no case of contamination of the treatment ward, depending on the dose and renal association. This suggests that patients' lifestyles or be affected by a variety of other factors.

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Expression of Phospholipase C Isozymes in Human Lung Cancer Tissues (인체 폐암조직에서 Phospholipase C 동위효소의 발현양상)

  • Hwang, Sung-Chul;Mah, Kyung-Ae;Choi, So-Yeon;Oh, Yoon-Jung;Choi, Young-In;Kim, Deog-Ki;Lee, Hyung-Noh;Choi, Young-Hwa;Park, Kwang-Ju;Lee, Yi-Hyeong;Lee, Kyi-Beom;Ha, Mahn-Joon;Bae, Yoon-Su
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.3
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    • pp.310-322
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    • 2000
  • Background : Phospholipase C(PLC) plays an important role in cellular signal transduction and is thought to be critical in cellular growth, differentiation and transformation of certain malignancies. Two second messengers produced from the enzymatic action of PLC are diacylglycerol (DAG) and inositol 1, 4, 5-trisphosphate (IP3). These two second messengers are important in down stream signal activation of protein kinase C and intracellular calcium elevation. In addition, functional domains of the PLC isozymes, such as Src homology 2 (SH2) domain, Src homology 3 (SH3) domain, and pleckstrin homology (PH) domain play crucial roles in protein translocation, lipid membrane modificailon and intracellular memrane trafficking which occur during various mitogenic processes. We have previously reported the presence of PLC-${\gamma}1$, ${\gamma}2$, ${\beta}1$, ${\beta}3$, and ${\delta}1$ isozymes in normal human lung tissue and tyrosine-kinase-independent activation of phospholipase C-${\gamma}$ isozymes by tau protein and AHNAK. We had also found that the expression of AHNAK protein was markedly increased in various mstologic types of lung can∞r tissues as compared to the normallungs. However, the report concerning expression of various PLC isozymes in lung canærs and other lung diseases is lacking. Therefore, in this study we examined the expression of PLC isozymes in the paired surgical specimens taken from lung cancer patients. Methods : Surgically resected lung cancer tissue samples taken from thirty seven patients and their paired normal control lungs from the same patients, The expression of various PLC isozymes were studied. Western blot analysis of the tissue extracts for the PLC isozymes and immunohistochemistry was performed on typical samples for localization of the isozyme. Results : In 16 of 18 squamous cell carcinomas, the expression of PLC-${\gamma}1$ was increased. PLC-${\gamma}1$ was also found to be increased in all of 15 adenocarcinoma patients. In most of the non-small cell lung cancer tissues we had examined, expression of PLC-${\delta}1$ was decreased. However, the expression of PLC-${\delta}1$ was markedly increased in 3 adenocarcinomas and 3 squamous carcinomas. Although the numbers were small, in all 4 cases of small cell lung cancer tissues, the expression of PLC-${\delta}1$ was nearly absent. Conclusion : We found increased expression of PLC-${\gamma}1$ isozyme in lung cancer tissues. Results of this study, taken together with our earlier findings of AHNAK protein-a putative PLD-${\gamma}$, activator-over-expression, and the changes observed in PLC-${\delta}1$ in primary human lung cancers may provide a possible insight into the derranged calcium-inositol signaling pathways leading to the lung malignancies.

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The Effect of TGF-{\beta}_1 on Cellular Activity of Periodontal Ligament Cells activated by PDGF-BB (PDGF-BB에 의한 치주인대세포활성에 대한 TGF-{\beta}의 효과)

  • Baek, Sang-Churl;Park, Jin-Woo;Suh, Jo-Young
    • Journal of Periodontal and Implant Science
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    • v.32 no.3
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    • pp.457-473
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    • 2002
  • The purposes of this study is to evaluate the combination effects of TGF-${\beta}_1$ and PDGF-BB on the periodontal ligament cells to use as a regeneration promoting agent of periodontal tissue. Human periodontal ligament cells were prepared from the first premolar tooth extracted for the orthodontic treatment and were cultured in DMEM/100% FBS at the $37^{\circ}C$, 5% $CO_2$ incubator. Authors measured the DNA synthesis, total protein, collagen and noncollagenous protein synthesis according to the concentration of TGF-${\beta}_1$,(1,5ng/ml) and PDGF-BB (1,10 ng/ml) in combination. To explore further this delayed effect of TGF-${\beta}_1$, we preincubated human periodontal ligament cells with TGF-${\beta}_1$ for 4 or 24 hours before PDGF-BB stimulation. The results were as follows: The DNA synthetic activity was increased dose dependently by TGF-${\beta}_1$, PDGF-BB. The combination of TGF-${\beta}_1$ and PDGF-BB consistently enhanced the DNA synthetic activity to PDGF-BB alone. The ability of TGF-${\beta}_1$ to enhance DNA synthetic activity in PDGF-BB treated periodontal ligament cells was dose dependent. The maximum mitogenic effect was at the 5ng/ml of TGF-${\beta}_1$ and l0ng/ml of PDGF-BB. Preincubation of cell with TGF-${\beta}_1$ resulted in significantly greater response to PDGF-BB at all TGF-${\beta}_1$ concentration studied, and may be useful for clinical application in periodontal regenerative procedures. The total protein, collagen and noncollagen synthesis was increased dose pendently by TGF-${\beta}_1$, PDGF-BB. The % of collagen was slightly decreased according to the concentration of TGF-${\beta}_1$, PDGF-BB. The effect of TGF-${\beta}_1$, PDGF-BB were not specific for collagen synthesis since it also increased noncollagenous protein synthesis. This study demonstrates that PDGF-BB is major mitogens for human periodontal ligament cells in vitro, and supports a role for TGF-${\beta}_1$ as a regulation of the mitogenic and total protein formation to PDGF-BB in these cells.

Radiation Therapy Alone for Early Stage Non-small Cell Carcinoma of the Lung (초기 비소세포폐암의 방사선 단독치료)

  • Chun, Ha-Chung;Lee, Myung-Za
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.323-327
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    • 2002
  • Purpose : To evaluate the outcome of early stage non-small cell lung cancer patients who were treated with radiation therapy alone and define the optimal radiotherapeutic regimen for these patients. Materials and Methods : A retrospective review was peformed on patients with sage I or II non-small cell carcinoma of the lung that were treated at our institution between June, 1987 and May, 2000. A total of 21 patients treated definitively with radiation therapy alone were included in this study. The age of the patients ranged from 53 to 81 years with a median of 66 years. All the patients were male. The medical reasons for inoperability were lack of pulmonary reserve, cardiovascular disease, poor performance status, old age, and patient refusal in the decreasing order. Pathological evidence was not adequate to characterize the non-small cell subtype in two patients. Of the remaining 19 patients, 16 had squamous cell carcinoma and 3 had adenocarcinoma. Treatment was given with conventional fractionation, once a day, five times a week. The doses to the primary site ranged from 56 Gy to 59 Gy. No patients were lost to follow-up. Results : The overall survival rates for the entire group at 2, 3 and 5 years were 41, 30 and $21\%$, respectively. The cause specific survivals at 2, 3 and 5 years were 55, 36 and $25\%$, respectively. An intercurrent disease was the cause of death in two patients. The cumulative local failure rate at 5 years was $43\%$. Nine of the 21 patients had treatment failures after the curative radiotherapy was attempted. Local recurrences as the first site of failure were documented in 7 patients. Therefore, local failure alone represented $78\%$ of the total failures. Those patients whose tumor sizes were less than 4 cm had a significantly better 5 year disease free survival than those with tumors greater than 4 cm $(0\%\;vs\;36\%)$. Those patients with a Karnofsky performance status less than 70 did not differ significantly with respect to actuarial survival when compared to those with a status greater than 70 $(25\%\;vs\;26\%,\;p>0.05)$. Conclusion : Radiation therapy 리one is an effective and safe treatment for early stage non-small ceil lung cancer patients who are medically inoperable or refuse surgery. Also we believe that a higher radiation dose to the primary site could improve the local control rate, and ultimately the overall survival rate.

The Clinical Significance of Follow Up SCC Levels in Patients with Recurrent Squamous Cell Carcinoma of the Cervix (재발성 자궁경부 편평상피암 환자들에서 Squamous Cell Carcinoma 항원의 유용성)

  • Choi Young Min;Park Sung Kwang;Cho Heung Lae;Lee Kyoung Bok;Kim Ki Tae;Kim Juree;Sohn Seung Chang
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.353-358
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    • 2002
  • Purpose : To investigate the clinical usefulness of a follow-up examination using serum squamous cell carcinoma antigen (SCC) for the early detection of recurrence in patients treated for conical squamous cell carcinoma. Materials and Methods : 20 patients who were treated for recurrent cervical squamous cell carcinoma between 1997 and 1998, who had experienced a complete remission after radiotherapy and who underwent an SCC test around the time when recurrence was detected, were included in this study. The levels of SCC were measured from the serum of the patients by immunoassay and values less than 2 ng/mL were regarded as normal. The sensitivity of the SCC test for use in the detection of recurrence, the association between the SCC values and the recurrence patterns and the tumor size and stage, and the temporal relation between the SCC increment and recurrence detection were evaluated. Results : The SCC values were above normal in 17 out of 20 patients, so the sensitivity of the SCC test for the detection of recurrence was $85\%$, and the mean and median of the SCC values were 15.2 and 9.5 ng/mL, respectively. No differences were observed in the SCC values according to the recurrence sites. For 11 patients, the SCC values were measured over a period of 6 months before recurrence was detected, and the mean and median values were 13.6 and 3.6 ng/mL, respectively. The SCC values of 7 patients were higher than the normal range, and the SCC values of the other 4 patients were normal but 3 among them were above 1.5 ng/mL. At the time of diagnosis, the SCC valuess were measured for 16 of the 20 recurrent patients, and the SCC values of the patients with a bulky tumor $(\geq4\;cm)$ or who were in stage IIb or III were higher than those of the patients with a non-bulky tumor or who were in stage Ib or IIa. Conclusion : The SCC test is thought to be useful for the early detection of recurrence during the follow up period in patients treated for cervical squamous cell carcinoma. When an effective salvage treatment is developed in the future, the benefit of this follow-up SCC test will be increased.

Problems of Environmental Pollution (환경오염의 세계적인 경향)

  • 송인현
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1972.03a
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    • pp.3.4-5
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    • 1972
  • 생활수준이 낮은 단계에 있어서는 우선 식량에 대한 수요가 강하다. 인간의 욕구가 만족스럽게 먹는다는 것에 대하여 제일 강하게 발동하는 것이다 그러나 점차 과학기술과 산업과 경제가 발전하여 성장과정에 오르게 되고 소득수준도 향상하게 되면 시장기구를 통해서 구입 할 수 있는 개인의 물적 소비재에 대해서는 점차 충족하게 되며 식량이외에도 의복, 전기기구 및 일용생활용품, 자동차 등에 이르기까지 더욱 고차원의 소비재가 보급하게 되는 것이다. 이렇게 되며는 사람의 욕구는 사적 재물이나 물적 수요에서 점진적으로 공공재나 또는 질적 수요(주택, 생활환경 등)의 방향으로 움직이게 되는 것으로써 여기에 환경오염 또는 공해문제에 대하여 의식하게 된다. 그러나 여기에서 더욱이 문제점이 되는 것은 소득 수준의 향상 과정이란 그 자체가 환경오염의 커다란 요인이라는 점이며 자동차의 급격한 보급과 생활의 편의성을 구하여 집중되는 도시인구의 집적, 높은 소득을 보장하기 위한 생산성 높은 중화학공업의 발전 등등은 그 자체가 환경권이란 사람이 요구하는 고차원의 권리를 침해하는 직접적인 요인이 된다는 것이다. 이와 같은 환경오염이나 공해문제에 대한 세계적인 논의는 이미 시작된 지 오래이지만 현재는 우리의 건강보호를 위해서나 생활환경의 보전을 위해서라는 점에서는 그치는 것이 아니고, 더욱 넓혀서 자연의 보호, 자원의 보호라는 견지로 확대되고 있다. 이와 같은 세계적인 확대된 이해와 이에 대한 대책강구의 제안은 1968년 국제연합의 경제사회이사회에서 스웨덴 정부대표에 의하여 제시되었으며 1969년의 우- 탄트 사무총장의 인간환경에 관한 보고서, 1970년 Nixon 미대통령의 연두일반교서 그리고 1972년 5월 6일 스웨덴의 스톡홀롬에서 개최되는 인간환경회의의 주제 등을 통해서 알 수 있고, 종래의 공해나 생활환경의 오염문제라는 좁은 개념에서가 아니고 인간환경전체의 문제로 다루고 있는 것이다. 즉 환경개발(도시, 산업, 지역개발에 수반된 문제), 환경오염(인위적 행위에 의하여 환경의 대인간조건이 악화하는 문제) 자연ㆍ자원의 보호관리(지하, 해양자원, 동식물, 풍경경치의 문제)란 3개 측면에서 다루고 있는 것이다. 환경오염이란 문제를 중 심하여 보면 환경을 구성하는 기본적인 요소로서 대기, 물, 토지 또는 지각. 그리고 공간의 사대요소로 집약하여 생각할 수 있음으로 이 4요소의 오염이 문제가 되는 것이다. 대기의 오염은 환경의 오염중 가장 널리 알려진, 또 가장 오랜 역사를 가진 오염의 문제로써 이에 속하는 오염인자는 분진, 매연, 유해가스(유황산화물, 불화수소, 염화수소, 질소산화물, 일산 화염소 등) 등 대기의 1차 오염과 1차 존재한 물질이 자외선의 작용으로 변화발생 하는 오존, PAN등 광화학물질이 형성되는 2차적인 오염을 들 수 있다. 기외 카도미움, 연등 유해중금속이나 방사선물질이 대기로부터 토지를 오염시켜서 토지에 서식하는 생물의 오염을 야기케 한다는 점등이 명백하여지고 있으며 대기의 오염은 이런 오염물질이 대기중에서 이동하여 강우에 의한 침강물질의 변화를 일으키게 되며 소위 광역오염문제를 발생케하며 동시에 토지의 토질저하등을 가져오게 한다. 물의 오염은 크게 내육수의 오염과 해양의 오염의 양면으로 나누어 볼 수 있다. 하천의 오염을 방지하고 하천을 보호하기 위한 움직임 역시 환경오염의 역사상 오래된 문제이며 시초에는 인분뇨와의 연결에서 오는 세균에 의한 오염이나 양수 기타 일반하수와의 연결에서 오는 오염에 대비하는 것부터 시작하였지만 근래에는 산업공장폐수에 의한 각종 화학적유해물질과 염료 그리고 석유화학의 발달에 의한 폐유등으로 인한 수질오탁문제가 점차 크게 대두되고 있다. 이것은 측 오염이란 시초에 우리에게 주는 불쾌감이 크므로 이것을 피하자는 것부터 시작하여 인간의 건강을 지키고 각종 사용수를 보존하자는 용수보존으로 그리고 이제는 건강과 용수보존뿐만 아니라 이것이 농림 수산물에 대한 큰 피해를 주게됨으로써 오는 자연환경의 생태계보전의 문제로 확대전환하고 있는 것이다. ?간 특히 해양오염에 대한 문제는 국지적인 것에만 끝이는 것이 아니고 전세계의 해양에 곧 연결되는 것이므로 세계각국의 공통관심사로 등장케 되었으며 이것은 특히 폐유가 유류수송 도중에 해양에 투기되는 유류에 의한 해양의 유막성형에서 오는 기상의 변화와 물피해등이 막심함으로 심각화 되고 있다. 각국이 자국의 해안과 해양을 보호하기 위하여 조치를 서두르고 있는 현시점에서 볼 때에는 이는 국제문제화하고 있으며 세계적인 국제적 협력과 협조의 필요성이 강조되는 좋은 예라 하겠다. 토양의 오염에 있어서는 대기나 수질의 오염이 구국적으로 토양과 관련되고 토양으로 환원되는 것이지만 근래에 많이 보급사용되는 농약과 화학비료의 문제는 토양자체의 오염에만 그치는 것이 아니고 농작물을 식품으로 하여 섭취함으로써 발생되는 인체나 기타생물체의 피해를 고려할 때 더욱 중요한 것이며, 또 토질의 저하를 가져오게 하여 농림생산에 미치는 영향이 적지 않을 것이다. 지반강하는 지각 에 주는 인공적 영향의 대표적인 것으로써 지하수나 지하 천연가스를 채취이용하기 위하여 파들어 감으로써 지반이 침하 하는 것이며 건축물에 대한 영향 특히 풍수해시의 재해를 크게 할 우려가 있는 것이다. 공간에 있어서의 환경오염에는 소음, 진동, 광선, 악취 등이 있다. 이들은 특수한 작업환경의 경우를 제외하고는 건강에 직접적인 큰 피해를 준다고 생각할 수 없으나 소음, 진동, 관선, 악취 등은 일반 일상시민생활에 불쾌나 불안을 줌으로써 안정된 생활을 방해하는 요인이 되는 것이다. 공간의 오염물로써 새로운 주목을 끌게된 것은 도시산업폐기물로써 이들은 대기나 물 또는 토지를 오염시킬 뿐만 아니라 공간을 점령함으로써 도시의 미관이나 기능을 손상케 하는 것이다. 즉 노배폐차의 잔해, 냉장고등고형폐기물등의 재생불가능한 것이나 비니루등 합성물질로 된 용기나 포장 등으로 연소분해 되지 않은 내구소비재가 이에 해당하는 것으로 이는 maker의 양식에 호소하여 그 책임 하에 해결되어야 할 문제로 본다. 이렇듯 환경오염은 각양각색으로 그 오염물질의 주요 발생원인 산업장이나 기타 기관에서의 발생요인을 살펴보며는 다음과 같은 것으로 요약할 수 있다. A. 제도적 요인 1. 관리체재의 미비 2. 관리법규의 미비 3. 책임소재의 불명확 B. 자재적 요인 1. 사용자재의 선택부적 2. 개량대책급 연구의 미흡 C. 기술적 요인 1. 시설의 설계불량, 공정의 결함 2. 시설의 점검, 보전의 불충분 3. 도출물의 취급에 대한 검사부족 4. 발생방지 시설의 미설치, 결함 D. 교육적 요인 1. 오염물질 방제지식의 결여 2. 법규의 오해, 미숙지 E. 경제적 요인 1. 자금부족 2. 융자상의 문제 3. 경제성의 문제 F. 정신적 요인 1. 사회적 도의심의 결여(이기주의) 2. 태만 3. 무지, 무관심 등이다. 따라서 환경오염의 방지란 상기한 문제의 해결에 기대하지 않을 수 없으나 이를 해결하기 위하여는 국내적 국제적 상호협조에 의한 사회각층의 총력적 대책이 시급한 것이다. 이와 같은 환경오염이 단속된다 하며는 미구에 인류의 건강은 물론 그 존립마저 기대하기 어려울 것이며, 현재는 점진적으로 급성피해에 대하여는 그 흥미가 집중되어 그 대비책도 많이 논의되고 있지만 미량의 단속접촉에 의한 만성축적에 관한 문제나 이와 같은 환경오염이 앞으로 태어날 신생률에 대한 영향이나 유전정보에 관한 연구는 장차에 대비하는 문제로써 중요한 것이라 생각된다. 기외에 우려되는 점은 오염방지책을 적극 추진함으로써 올 수 있는 파생적인 문제이다. 즉 오염을 방지하기 위하여 생산기업체가 투자를 하게 되며는 그만큼 생산원가가 상승할 것이며 소비가격도 오를 것이다. 반면 이런 시책에 뒤떨어진 후진국의 값싼 생산국은 자연 수입이 억제 당할 것이며, 이렇게되면 후진국은 무역경쟁에서 큰 상처를 입게될 것이고 뿐만 아니라 선진국에 필요한 오염물질의 발생이 높은 생산기기를 자연후진국에 양도하게 될 것임으로 후진국의 환경오염은 배가할 우려가 있는 것이다. 또 해양오염을 방지할 목적에서와 같이 자국의 해안보호를 위하여 마련된 법의 규제는 타국의 선박운항에 많은 제약을 가하게 될 것이며 이것 역시 시설이 미약한 약소후진국의 선박에 크게 영향을 미치게 될 것임으로 교통, 해운, 무역등을 통한 약소후진국의 경제성장에 제동을 거는 것이 될 것이다. 이렇듯 환경오염의 문제는 환경자체에 대해서만 아니라 부산물적으로 특히 후진국에는 의외 문제를 던져주게 되는 것임으로 환경오염에 대해서는 물론, 전술한 바와 같이 인간환경전체의 문제로써 Nixon 대통령이 말한 결의와 창의와 그리고 자금을 가지고 과감하게 대처해 나가야 할 것이다.

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