반회후두신경 손상을 동반하지 않은 갑상선 절제술 환자에서 수술 초기의 음성 및 연하 기능의 변화에 대한 분석

김희진,금보람,김근희,전승식,김혜진,김성균,홍석진,홍석민,김용복,박일석,Kim, Heejin,Keum, Bo-Ram,Kim, Geun Hee,Jeon, Seung Sik,Kim, Hyejeen,Kim, Sung Kyun,Hong, Seok Jin,Hong, Seok-Min,Kim, Yong-Bok,Park, Il-Seok 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.2

Background and Objectives : After thyroidectomy, many patients experience problems report such things as reduced voice range and vocal fatigue, swallowing problems without superior and recurrent laryngeal nerve injury. The purpose of this study was to evaluate voice and swallowing problems before and after thyroid surgery without laryngeal nerve injury. Materials and Methods : Ninety-three patients who underwent thyroidectomy without laryngeal nerve injury and completed the follow-up evaluations were studied between June 2013 and December 2015. Each evaluation was performed preoperatively, as well as 1 week, 1 month postoperatively. Analysis was performed including voice handicap index (VHI), dysphagia handicap index (DHI), and acoustic voice analysis. Results : Patients show significant variation of parameters in the fundamental frequency (F), maximal phonation time (MPT), shimmer, jitter and soft phonation index (SPI) early after operation, and most of them showed recovery of parameters after 1month of operation. Perceptive complaint of voice and swallowing also showed significant decreased after operation (p<0.005). After 1month of operation, MPT, highest frequency and frequency ranges still showed significant decreased parameters. Comparing acoustic and perceptive parameters of total thyroidectomy and lobectomy, there was no significant changes between them except highest frequency (p=0.042). Conclusion : The results from both subjective and objective evaluations show voice and swallowing disturbance after thyroidectomy even in the absence of laryngeal nerve and provide patients information about the recovery process after surgery. Highest frequency parameter showed most significant changes after operation.

간 전이 암 환자의 18F-FDG PET 기반 종양 영역 정의: 영상 인자와 자동 영상 분할 기법 간의 관계분석

김희진,박승우,정해조,김미숙,유형준,지영훈,이철영,김금배,Kim, Heejin,Park, Seungwoo,Jung, Haijo,Kim, Mi-Sook,Yoo, Hyung Jun,Ji, Young Hoon,Yi, Chul-Young,Kim, Kum Bae 한국의학물리학회 2013 의학물리 Vol.24 No.2

간 전이 암은 이전에는 수술을 통한 외과적 절제가 주요 치료기법이었지만 방사선 치료 기법의 발전으로 인해 점차 방사선치료의 시행이 늘어나고 있다. 18F-FDG PET 영상은 간 전이 암 진단 시 더욱 우세한 민감도와 특이도를 보이며, 치료계획용 CT 영상과 더불어 종양조직의 위치를 정의하는 중요한 영상장비로 자리매김하고 있다. 본 연구에서는 간 전이 암의 18F-FDG PET 영상에 나타난 종양영역을 영상분할기법 적용하였으며 PET영상의 여러 인자들이 영상분할기법들에 미치는 영향을 알아보았다. 2009년부터 2012년까지 방사선 치료를 받은 간전이 환자들 중 18F-FDG PET/CT 촬영을 시행한 13명의 환자들의 치료계획용 CT와 PET/CT 영상을 얻었다. 그 뒤 PET 영상의 관심영역을 설정하기 위하여 3가지 영상 분할 기법인 상대적문턱기법, 기울기기법, 영역성장기법을 적용하였다. 이 결과들을 바탕으로 GTV와 각 영상 기법으로 구현된 종양 영역과 부피 비교를 시행하였으며 영상 분할 기법에 영향을 미치는 영상인자들과의 관계를 회귀 분석하였다. GTV (Gross Tumor Volume)의 평균 부피는 $60.9{\pm}65.9$ cc이며, 40% 상대적문턱값 기법은 $22.43{\pm}35.3$ cc, 50% 상대적문턱값 기법은 $10.11{\pm}17.9$ cc, 영역성장기법은 $32.89{\pm}36.8$ cc, 기울기기법은 $30.34{\pm}35.8$ cc로 나타났다. 기존의 GTV와 가장 유사한 영역을 나타낸 영상 분할 기법은 영역성장기법 이었다. 이 영역성장기법에 영향을 미치는 영상인자를 정량적으로 분석하기 위해 표준화 계수 ${\beta}$값을 이용하였으며, GTV의 크기, $TumorSUV_{MAX/MIN}$, $SUV_{max}$, TBR 순으로 나타났다. 이와 같은 PET 영상인자를 반영한 영상 분할 기법을 이용해서 종양 영역을 정의한다면 보다 정확하고 일관성 있는 종양그리기를 수행할 수 있으며 궁극적으로 종양에 최적화된 방사선량을 투여할 수 있을 것이다. The surgical resection was occurred mainly in liver metastasis before the development of radiation therapy techniques. Recently, Radiation therapy is increased gradually due to the development of radiation dose delivery techniques. 18F-FDG PET image showed better sensitivity and specificity in liver metastasis detection. This image modality is important in the radiation treatment with planning CT for tumor delineation. In this study, we applied automatic image segmentation methods on PET image of liver metastasis and examined the impact of image factors on these methods. We selected the patients who were received the radiation therapy and 18F-FDG PET/CT in Korea Cancer Center Hospital from 2009 to 2012. Then, three kinds of image segmentation methods had been applied; The relative threshold method, the Gradient method and the region growing method. Based on these results, we performed statistical analysis in two directions. 1. comparison of GTV and image segmentation results. 2. performance of regression analysis for relation between image factor affecting image segmentation techniques. The mean volume of GTV was $60.9{\pm}65.9$ cc and the $GTV_{40%}$ was $22.43{\pm}35.27$ cc, and the $GTV_{50%}$ was $10.11{\pm}17.92$ cc, the $GTV_{RG}$ was $32.89{\pm}36.8$4 cc, the $GTV_{GD}$ was $30.34{\pm}35.77$ cc, respectively. The most similar segmentation method with the GTV result was the region growing method. For the quantitative analysis of the image factors which influenced on the region growing method, we used the standardized coefficient ${\beta}$, factors affecting the region growing method show GTV, $TumorSUV_{MAX/MIN}$, $SUV_{max}$, TBR in order. The result of the region growing (automatic segmentation) method showed the most similar result with the CT based GTV and the region growing method was affected by image factors. If we define the tumor volume by the auto image segmentation method which reflect the PET image parameters, more accurate and consistent tumor contouring can be done. And we can irradiate the optimized radiation dose to the cancer, ultimately.

그래핀/구리폼과 그래파이트 하이브리드 구조체의 열전도 특성 연구

김희진,김형근,김예나,이우성,윤대호,양우석,Kim, Hee Jin,Kim, Hyeungkeun,Kim, Yena,Lee, Woo Sung,Yoon, Dae Ho,Yang, Woo Seok 한국결정성장학회 2013 한국결정성장학회지 Vol.23 No.5

그래핀(Graphene)은 전기 전도성 및 열전도성이 우수하고 1 nm 수준의 초 박막 형 필름 소재를 제조할 수 있다는 장점으로 인하여, 차세대 트랜지스터 소자 및 디스플레이 장치에 적용 가능한 방열 소재로서 많은 연구가 활발히 진행되고 있다. 또한 CVD(chemical vapor deposition)제조법으로 합성된 그래파이트(Graphite)는 구조의 단순성 및 유연성 때문에 안정하고 열에 강한 탄소계 방열소재로 주목 받고 있다. 본 연구는 열전도도가 우수한 폼(foam)형태의 구리를 촉매로 상압과 진공에서의 CVD법을 이용하여 그래핀을 성장시킨 후 구리 폼의 기공 안에 다양한 종류의 그래파이트(Natural graphite, expandable(/expanded) graphite, etc)를 복합 및 안정화시켜 기존보다 높은 열전도도를 가지는 방열소재를 개발하였다. 제조된 금속폼/그래파이트 소재를 OM(optical microscopy)과 SEM(scanning electron microscopy)을 이용하여 표면을 확인하였고 DSC(Differential Scanning Calorimetry), 아르키메데스 법을 활용한 비열, 밀도 결과를 확보하였다. 또한 LFA(Laser Flash Analysis)를 이용하여 열 확산계수 예측을 통한 열전도 특성을 평가하였다. Pure-carbon materials such as graphite, graphene, carbon nanotubes, and diamond have very high thermal conductivities. The reported thermal conductivity of graphene is in the range 3000~5000W/m-K at room temperature. Here, we developed graphene/cu foam hybrid type heat spreader to obtain higher thermal conductivity than Cu foam. Hybrid materials were characterized using optical microscopy (OM), scanning electron microscopy (SEM) and thermal conductivity measurement system; LFA (Laser Flash Analysis @ LFA 447, NETZSCH). We suggest that excellent thermal properties of graphene/cu foam hybrid structures are beneficial for all proposed electrical applications and can lead to a thermal management application.

다제내성과 광역내성 결핵의 치료 (2)

김희진,Kim, Hui-Jin 대한결핵협회 2007 보건세계 Vol.54 No.7

소아에서 EMLA cream을 이용한 도포마취 : 증례보고

김희진,고승백,홍성수,이창섭,이상호,Kim, He-Jin,Ko, Sung-Back,Hong, Seong-Soo,Lee, Chang-Seop,Lee, Sang-Ho 대한소아치과학회 2002 大韓小兒齒科學會誌 Vol.29 No.1

치과치료를 위하여 마취를 시행할 때 아동들의 주사기나 주사바늘에 대한 불편감을 감소시키기 위한 여러 방법들이 있다. 도포마취제의 사용이 한 가지 방법이다. 도포마취는 많은 임상과정, 즉 주사침 자입부위, 간단한 유치발치, 구토반응이 심한 환자에서 치과용 구내 방사선 촬영시, 인상채득 전 구토반응의 감소 목적 등으로 사용되어 왔다. 또한 소아에서 치면열구전색술과 예방심미수복술시 치아격리를 위한 러버댐 clamp의 장착은 불편감을 유발할 수 있는데, 도포마취는 이런 목적으로 러버댐 장착시 도움이 된다. 모든 구강내 도포마취제는 점막에 동등한 효과가 있다고 제안되었으나, 1980년대 개발되어 피부의 표면마취에 사용되는 EMLA(acronym for eutectic mixture of local anaesthetics)가 기존의 도포마취제보다 부착치은에 사용시 더 효과가 있다고 보고되고 있다. 본 증례에서는 침윤마취가 필요한 몇 증례에서 EMLA cream을 이용하여 국소마취를 하기 전단계, 유치 발거시, clamp 장착시, 기성관 수복 등에서 동통을 감소시킴으로써 환아의 치과 치료에 대한 불안감을 감소시키는데 매우 효과적이었기에 보고하는 바이다. A number of techniques may be employed to reduce the discomfort of syringe or needle for dental care. The use of topical anesthesia is one such method. Topical anesthetics are applied to alleviate pain during many clinical procedures, such as injection of local infiltration anesthetics, primary tooth extraction, X-ray taking of sensitive patients, reducing gag reflex prior to impression taking. In children, placement of a rubber dam clamp, however, may cause significant discomfort for purpose of pit and fissure sealant and preventive resin restoration(PRR). A topical anesthetic would be beneficial to aid in rubber dam placement for this purpose. It has been suggested that all intra-oral topical anesthetics are equally effective on reflected mucosa, however EMLA(an acronym for eutectic mixture of local anesthetics), which was developed in the 1980s and produces surface anesthesia of skin, has been shown to be more effective than conventional topical anesthetics when used on attached gingivae. This report is topical anesthesized 4 case by EMLA cream, who showed better effect in reducing the pain of infiltration anesthesia, extraction of deciduous teeth, rubber dam clamp placement and reducing the pain of preformed crown adaptation.

다제내성과 광역내성(XDR) 결핵의 치료 (1)

김희진,Kim, Hui-Jin 대한결핵협회 2007 보건세계 Vol.54 No.6

TB클리닉 - 결핵 치료시 흔히 접하는 문제들

김희진,Kim, Hui-Jin 대한결핵협회 2010 보건세계 Vol.57 No.1

IPS Empress 도재관의 파절강도 : 하악 제2소구치에서 교합면 두께와 축면 경사도에 따른 영향

김희진,이해형,남영성,동진근,Kim Hee-Jin,Lee Hae-Hyoung,Nam Young-Sung,Dong Jin-Keun 대한치과보철학회 2002 대한치과보철학회지 Vol.40 No.5

The purpose of this study was compare the fracture strength of the IPS Empress ceramic crown according to the occlusal depth (1.5mm, 2.0mm, 2.5mm) and axial inclination ($4^{\circ},\;8^{\circ},\;12^{\circ}$) of the lower second premolar. After 10 metal dies were made for each group, the IPS Empress ceramic crowns were fabricated and cemented with resin cement. The cemented crowns were mounted on the testing jig with inclination of 30 degrees and the universal testing machine was used to measure the fracture strength. The results of this study were as follows : 1. The fracture strength of the ceramic crown with 2.5mm depth and $12^{\circ}$ inclination was the highest (1284 N). Crowns of 1.5mm depth and $8^{\circ}$ inclination had the lowest strength (951 N). 2. There were no significant differences in the fracture strength by axial inclination of the same occlusal depth group. 3. Most fracture lines began at the loading area and extended through proximal surface perpendicular to the margin, irrespective of occlusal depth.

타액선 신티그라피를 이용한 정상 타액선기능의 정량분석

김희진,고명연,박준상,Kim, Hui-Jin,Ko, Myung-Yun,Park, June-Sang 대한안면통증구강내과학회 2000 Journal of Oral Medicine and Pain Vol.25 No.4

This study was to investigate normal salivary flow rates and normal indices of Quantitative analysis of salivary scintigraphy. 96 adult volunteers were studied by Questionnaire evaluating salivary conditions and clinical examinations. 35(male 23, female 12, age range 23-31years) that absented subjective and objective symptoms related saliva were classified as normal group. The normal group underwent measurement unstimulated and stimulated salivary flow rates and salivary scintigraphy. The obtained results were as follows: 1. There were not significant in sex differences of unstimulated and stimulated salivary flow rates. The unstimulated salivary flow rate was $0.66{\pm}0.41g/min$, stimulated salivary flow rates was $1.61{\pm}0.69g/min$. 2. As comparing of parameters of salivary scintigraphy, the Uptake ratio(UR), $T_{max}$, $T_{min}$, Maximum accumulation (MA), Maximum secretion(MS) of parotid and submandibular glands were not significant in sex and side-ralated differences. 3. The UR, $T_{max}$, MA, MS of parotid gland were significantly higher than those of submandibular gland; in the parotid gland, UR, $3.67{\pm}0.88$, $T_{max}$, $18.77{\pm}0.43min$, MA, $41.35{\pm}9.22%$, MS, $43.13{\pm}9.13%$; in the submandibular gland, UR, $3.04{\pm}0.10$, $T_{max}$, $18.48{\pm}0.52min$, MA, $36.47{\pm}14.18%$, MS, $36.88{\pm}12.20%$. 4. As classifying of time-activity curve, the most of parotid gland was N-type(97.1%), submandibular gland was observed in order of M-type(67.1%), N-type(21.4%), F-type(11.4%), however, was not observed S-type. 5. As the type of time-activity curve of submandibular gland was more flattened, the UR, $T_{max}$, MA, MS were significantly decresed.

세계 결핵 추세와 우리나라 결핵실태

김희진,Kim, Hui-Jin 대한결핵협회 2007 보건세계 Vol.54 No.3