응급의학과 전공의 교육을 위한 제언

백광제,박승희,선경,장연희,엄병선,홍윤식 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Although the medical science in Korea has experienced remarkable development, both qualitatively and quantitatively, since its introduction at the beginning of the 20th century, its main focus has been on the expansion of spcialized treatment and medical care in general. However, the fast-paced economic development that started in the 1960's has caused substantial increases in cerbrovascular disease and coronary artery disease while the industrial development and in creased use of means of transportation have resulted in the rapid rise of incidents in external injuries. Consequently, the public has become acutelyh aware of the need for fast and effective emergency transportation and treatemnt. Such awareness also stems from the wide avalilability of medica care which is now established as a basic citizen's right as a result of the national medical insturance system that started in 1977 and was fully implemented in 1989. In response to the public demand for effetive emergency treatments, kthe health care sector has been making serious efforts to deliver better emergency treatments by expanding the emergency facilities and newly offering emergency training programs. Several hospitals have already commenced training programs in order to provide personnel specially trained in that area. The emergency medicine requires not only specialized training in the emergency treatment program in emergency should be designed in order to adapt to the specific needs of the Koreans, as based on epidemiological studies of the nature of emergency cases, its distribution in the population by ages and nature of injury, admission ratio, death rates, etc. currently prevailing in Korea. The present research has been carried out by the Korea university Hospital in preparation of the commencement of the emergency training program in 1994. The research consists of analysis of the emergency cases admitted in the Emergency center of Korea University Hospiatl from January 1992 to December 1992, its distribution, nature, and statistics regarding admission. Based on our research and our review of other available literature on the subject, we make the following suggestions regarding the specialized training program for emergency treatment. 1. The trainees must be required to be also t4rained in the areas of internal medicine surgery, obstetrics and pediatrics. 2. The training in internal medicine should include gastrointestinal, espiratory, cardiovascular medicine and nephrology which the training in surgery should include general surgery, neurosurgery and cardiac surgery. 3. The program should provide training for effective and accurate reading of the radiology. 4. The trainees should be required to participate in actural emergency treatment activities in order to have opportunities to acquire practical skills as well as theoretical knowledge. 5. The program should include course in medical management which would be necessary for effective management and administration of emergency centers and facilities. 6. The continued development of the program would require extensive studies and researches supported by the academic associations of medicine.

급성 포름알데히드 가스 흡입에 의한 흰쥐 후각상피의 형태학적 변화

백선용,전재기,문용석,황승영,노환중,고의경,왕수건 대한해부학회 1998 Anatomy & Cell Biology Vol.31 No.3

조리유형별 메뉴의 노동강도 측정에 관한 연구

백승희,양일선,김효정 한국조리과학회 2004 한국식품조리과학회지 Vol.20 No.4

The purpose of this study was to measure the labor intensity of menus according to various cooking types. Through a literature review and in-depth interview, the attributes that affected the labor intensity were identified as the level of skill, amount of effort, degree of tiredness, time consumed, and machine usage. A survey was conducted in April, 2001 among cooks who knew the entire process of cooking. There was a strong positive correlation between labor intensity and labor intensity attributes. Through regression analysis, a regression equation was obtained between labor intensity and labor intensity attributes. The labor intensity index calculated from this study showed the extent of labor intensity of menus. The result of this study could be used as basic data for foodservice managers to establish a menu planning and work schedule based on a scientific method.

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.

아말감과 복합레진의 수복 과정과 수복 후 발생하는 상아세관액 흐름의 실시간 측정

김선영,조병훈,백승호,임범순,이인복 대한치과보존학회 2009 Restorative Dentistry & Endodontics Vol.34 No.6

본 연구의 목적은 아말감과 복합레진의 수복 과정과 수복 후 상아세관액의 흐름(dentinal fluid flow, DFF)을 측정하기 위함이다. 치근을 절제한 제 3 대구치를 자체 제작한 미세 유체 흐름 측정장치에 연결한 후 1급 와동을 형성하여 아말감과 복합레진 수복을 시행하였다. DFF의 측정은 와동 형성부터 수복 후 30분까지 연속적으로 이루어졌고, 수복 후 3, 7일에 재 측정하였다. 주수 하에 와동 형성 시 DFF는 inward로, 끝난 후에는 outward로 바뀌었다. 아말감 충전 시 DFF는 inward로 바뀌었고 충전 완료 후 미약한 outward DFF를 보였다. 복합레진 수복의 경우, 산 처리 후 수세와 건조 시 각각 inward와 outward DFF를 보였고 primer도포 후 공기 분사는 급격한 outward, 소수성 본딩제를 적용하는 단계에서는 outward 였던 DFF가 감소하여 0에 가까워지거나 약간 inward 흐름을 보였다. 접착제와 복합레진의 광중합은 급격한 inward의 DFF를 일으켰다. 수복 후 30분, 3일, 7일째 수복 재료에 따른 DFF의 감소에 통계적으로 유의한 차이는 없었다 (p>0.05). The aim of this study was to measure the dentinal tubular fluid flow (DFF) during and after amalgam and composite restorations. A newly designed fluid flow measurement instrument was made. A third molar cut at 3 mm apical from the CEJ was connected to the flow measuring device under a hydrostatic pressure of 15 . Class I cavity was prepared and restored with either amalgam (Copalite varnish and Bestaloy) or composite (Z-250 with ScotchBond MultiPurpose: MP, Single Bond 2: SB, Clearfil SE Bond: CE and Easy Bond: EB as bonding systems). The DFF was measured from the intact tooth state through restoration procedures to 30 minutes after restoration, and re-measured at 3 and 7days after restoration. Inward fluid flow (IF) during cavity preparation was followed by outward flow (OF) after preparation, In amalgam restoration, the OF changed to IF during amalgam filling and slight OF followed after finishing. In composite restoration, application CE and EB showed a continuous OF and air-dry increased rapidly the OF until light-curing, whereas in MP and SB, rinse and dry caused IF and OF, respectively. Application of hydrophobic bonding resin in MP and CE caused a decrease in flow rate or even slight IF. Light-curing of adhesive and composite showed an abrupt IF. There was no statistically significant difference in the reduction of DFF among the materials at 30 min. 3 and 7 days after restoration (p > 0.05).

위암환자의 복강내에 투여한 Mitomycin C-Carbon Particle의 Mitomycin 용출에 관한 연구

노승무,조영훈,정경수,오정연,김진향,양준묵,강대영,송규상,조준식,최선웅,이진호,민병무,김용백,김창식,박근성,인현빈,정현용,김학용 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Locoregional recurrence is the most common type of recurrence in surgical operation of gastric adenocarcinoma, and peritoneal dissemination is one of the most difficult problems in advanced gastric adenocarcinoma treatment. Because the peritoneal cavity is the most common site of the first recurrence after gastric cancer resection, intraperitoneal chemotherpy seems a logical choice for cancer chemotherapy. The Mitomycin C(MMC) adsorbed by the activated charcoal particles(CH) is relatively released when the drug concentration surrounding the carbon particles becomes low in the peritoneum of the peritoneal cavity. For the intraperitoneal chemotherapy on the advanced gastric adenocarcnoma, mitomycin C adsorbed on activated carbon particles was administered in the peritoneal cavity just before abdominal wall closure. The closed drainage tubes were inserted in the peritoneal cavity and clamped for tuo hours after completion of operation. MMC concentrations were serially measured in peritoneal fluid, plasma and urine at 2hour, 48 hour, 72 hour and 168 hour following its administration in order to study the efficacy of the MMC-CH as a drug delivery system. There were minimal toxicities in born marrow, liver, and gastrointestinal system after intraperitoneal MMC-CH administration. The data of this study suggested that MMC-CH may have a somewhat more beneficial effect than surgery alone when administered in optimal dose and schedules, but the MMC concentration of the peritoneal fluid was not sufficient to eradicate remnant cancer cells, and effective duration of maintenance was only below 24 hours in the peritoneal fluid and plasma.

Rat의 복강에 삽입한 Filorouracil-Polyglycolic acid제형의 Fluorouracil용출에 관한 연구

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

A common form of relapse in adenocarcinoma of the stomach is intraperitioneal dissemination, in fact, among gastric adenocarcinoma patients who have undergone surgery intended to cure, approximately 50% of the patients develope initial recurrence in the peritoneal cavity regardless of the anatomic site of the primary tumor within the stomach. The efficacy of systemic postoperative chemotherapy to prevent peritoneal recurrence of gastrric adenocarcinoma is not satisfactory. There is still a great need for improved therapeutic strategies on the disseminated microscopic disease and small miliary nodules remaining on the peritoneal surface or lymphatics after operation. The authers have made fluorouracil-polyglycolic acid composite disks(Fu-PGA disks) with fluorouracil and biodegradable polymer: polyglycolic acid for more effective intraperitoneal chemotherapy. We inserted the Fu-PGA disk(s) in the peritoneal cavity of rat and pharmacokinetic study was performed to measure fluorouracil concentration in the peritoneal fluid, plasma, liver, kidney and heart tissue at 24 hour, 72 hour and 168 hour after insertion of Fu-PGA disk(s). Myelosuppressive action of this composite also was determined following its administration. The data of this study suggested that Fu-PGA composite will be a new device releasing drugs in a controlled manner and having targetability to peritoneum, and this device will be improving the efficacy of intraperitoneal chemotherapy for gastric adenocarcinoma.

흉부외상 없이 발생한 흉부대동맥 절단증의 조기 진단 : 2례 보고 Two Cases Report

한승백,전영진,백광제,김준식,김정택,김광호,선경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Aortic transection or interruption is a rare condition which developed after an acute deceleration injury. Its occurrence depends on the location and direction of the force applied and is usually from motor vehicle accident or falling down. The exact incidence of aortic transection in trauma is not known but, when develops, only about 10-15% of the victims can survive and be transported to the hospital. Even in the survivors, majority of them will be fatal within a few days if a prompt diagnosis and surgical treatments are not made. Aggressive diagnostic work-up is recommended for the patients with high suspicious index, which would salvage the victims with this fatal condition. We report the experience of two cases of aortic transection or interruption following motor vehicle accidents.

Layering시 복합레진 층간의 계면 결합에서 oxygen inhibition layer가 필수적인가?

김선영,조병훈,백승호,이인복 大韓齒科保存學會 2008 Restorative Dentistry & Endodontics Vol.33 No.4

본 연구의 목적은 여러 가지 계면조건의 변화를 통해서 layering 시 복합레진 층간의 결합에 oxygen inhibition layer (OIL)가 필수적인지를 고찰해보는 것이다. 가로 × 세로 × 두께가 16 × 28 × 2.5 ㎜인 알루미늄판에 지름 3.7 ㎜의 구멍을 형성하여 몰드를 제작하고 다음과 같이 복합레진 (Z-250, 3M ESPE)을 충전하여 광중합하였다. 1 군: 하층판에 복합레진을 충전하고 광중합 한 후, 상층판을 접합하고 레진을 충전하여 광중합을 하였다 (OIL를 남김). 2군: 하층판에 복합레진을 충전하고 팡중합 한 후 acetone에 적신 cotton으로 문질러서 OIL를 제거하고 상층판을 접합하여 복합레진을 충전하고 광중합을 하였다 (OIL를 제거). 3군: 하층판에 복합레진을 충전하고 Mylar strip을 접합하여 공기와의 접촉을 차단한 후 광중합을 하였다. Mylar strip을 제거하고 상층판을 접합 후 복합레진을 충전하여 광중합을 하였다 (OIL형성을 억제). 4군: 하층판에 복합레진을 충전하고 광중합 한 후 glycerin을 OIL표면에 도포하고 다시 광중합하였다. 상층판을 접합하여 복합레진을 충전하고 광중합을 하였다 (OIL를 중합). 5군 (대조군): 하층판과 상층판의 경계에 복합레진층의 계면이 위치하지 않도록 복합레진을 bulk충전하였다 (계면 형성 없이 bulk 충전한 복합레진). 24시간 100% 습도에서 보관 후 상층판과 하층판 사이의 계면 전단결합강도를 측정하고 파절 양상을 관찰하였다. 계면을 통한 중합과정의 확산을 관찰하기 위하여 제조한 광개시제가 들어있지 않은 실험적 복합레진 (Exp_Com)을 몰드에 충전하고 상부에 flowable 복합 레진 (Aelite Flow) 또는 접착레진 (ScotchBond Multipurpose)을 접촉시킨 후 광조사하였다. 몰드내의 미중합된 Exp_Com을 acetone bath 에서 5 분 동안 제거한 후 몰드내에 다시 Aelite Flow를 충전하고 광중합을 시행하였다. 경화된 복합레진 시편의 단면을 관찰하여 ExP_Com 층의 두께를 측정하였다. OIL를 배제하거나 중합시킨 2-4 군은 OIL이 존재하는 1 군과 통계적으로 유의한 결합강도의 차이를 보이지 않았으며, Mylar strip을 이용하여 OIL의 생성을 억제했던 3 군과 glycerin을 도포하여 OIL를 중합시킨 4 군은 계면을 생성하지 않은 대조군인 5 군과도 통계적으로 유의한 차이를 보이지 않았다. 중합과정의 확산에 의해 중합개시제가 포함되지 않은 Exp_Com내에 중합된 층이 생겨난 것을 시각적으로 확인할 수 있었으며, Exp_Com의 중합층 두께는 flowable 레진의 경우 20,95 (0.90) um였고 접착레진의 경우 42.13 (2.09) 였다. This study was aimed to investigate whether an oxygen inhibition layer (OIL) is essential for the interfacial bonding between resin composite layers or not. A composite (Z-250, 3M ESPE) was filled in two layers using two aluminum plate molds with a hole of 3.7 ㎜ diameter. The surface of first layer of cured composite was prepared by one of five methods as followings. thereafter second layer of composite was filled and cured: Group 1 - OIL is allowed to remain on the surface of cured composite; Group 2 - OIL was removed by rubbing with acetone-soaked cotton; Group 3 - formation of the OIL was inhibited using a Mylar strip; Group 4 - OIL was covered with glycerin and light-cured; Group 5 (control) - composite was bulk-filled in a layer. The interfacial shear bond strength between two layers was tested and the fracture modes were observed. To investigate the propagation of polymerization reaction from active area having a photo-initiator to inactive area without the initiator, a flowable composite (Aelite Flow) or an adhesive resin (Adhesive of ScotchBond Multipurpose) was placed over an experimental composite (Exp_Com) which does not include a photoinitiator and light-cured. After sectioning the specimen, the cured thickness of the Exp_Com was measured. The bond strength of group 2, 3 and 4 did not show statistically significant difference with group 1. Groups 3 and 4 were not statistically significant different with control group 5. The cured thicknesses of Exp_Com under the flowable resin and adhesive resin were 20.95 (0.90) um and 42.13 (2.09), respectively.

Rat의 복강에 삽입한 Fluorouracil-Polyglycolic acid 제형의 Fluorouracil 용출에 관한 연구

노승무,정경수,오정연,김진향,양준묵,강대영,송규상,최정목,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 忠南大學校 癌共同硏究所 1998 癌共同硏究所 硏究誌 Vol.2 No.1

A common form of relapse in adenocarcinoma of the stomach is intraperitoneal dissemination, in fact, among gastric adenocarcinoma patients who have undergone surgery intended to cure, approximately 50% of the patients develope initial recurrence in the peritoneal cavity regardless of the anatomic site of the primary tumor within the stomach. The efficacy of systemic postoperative chemotherapy to prevent peritoneal recurrence of gastrric adcnocarcinoma is not satisfactory. There is still a great need for improved therapeutic strategies on the disseminated microscopic disease and small miliary nodules remaining on the peritoneal surface or lymphatics after operation. The authers have made fluorouracil-polyglycolic acid composite disks(Fu-PGA disks) with fluorouracil and biodegradable polymer: polyglycolic acid for more effective intraperitoneal chemotherapy. We inserted the Fu-PGA disk(s) in the peritoneal cavity of rat and pharmacokinetic study was performed to measure fluorouracil concentration in the peritoneal fluid, plasma, liver, kidney and heart tissue at 24 hour, 72 hour and 168 hour after insertion of Fu-PGA disk(s). Myelosuppressive action of this composite also was determined following its administration. The data of this study suggested that Fu-PGA composite will be a new device releasing drugs in a controlled manner and having targetability to peritoneum, and this device will be improving the efficacy of intraperitoneal chemotherapy for gastric adenocarcinoma.