공황장애 치료에 대한 한국형 알고리듬 개발(1) - 배경, 조직구성, 알고리듬 개발의 원칙, 개발계획, 개발방법

이상혁,유범희,김찬형,윤세창,Lee, Sang-Hyuk,Yu, Bum-Hee,Kim, Chan-Hyung,Yoon, Se-Chang 대한불안의학회 2007 대한불안의학회지 Vol.3 No.2

In this special article, we presented the organization of the work group, basic principles of the algorithm, future plan and methods for developing a treatment algorithm for panic disorder in Korea. The psychiatrist work group from the Korean Association of Anxiety Disorders began to develop a treatment algorithm designed to improve the management of Korean patients with panic disorder by incorporating better evaluation techniques and treatment procedures. We have reviewed the treatment guidelines and algorithms for panic disorder published thus far, including the Practice Guideline for the Treatment of Patients with Panic Disorder established by the American Psychiatric Association, the Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalized Anxiety Disorder) in Adults in Primary, Secondary and Community Care established by the National Institute for Clinical Excellence, and the Clinical Practice Guidelines established by the Canadian Psychiatric Association. We developed the basic materials to be used in the treatment algorithm for the management of panic disorder in Korea. Therefore, in this special article, we intro-duce the goal of the algorithm and the details of the algorithm development.

VMS 교통정보의 교통안전효과에 관한 연구

이상혁,조혜진,Lee, Sang Hyuk,Cho, Hye Jin 한국ITS학회 2015 한국ITS학회논문지 Vol.14 No.1

최근 교통문제를 완화하기 위하여 ITS를 적용하는 도로가 늘어나고 있다. 특히 가변전광표지(VMS: Variable Message Sign)는 전방도로상황, 기상상황 등 교통정보를 제공하여 교통흐름관리 및 교통안전관리를 하는 ITS 중 하나이다. 이런 VMS의 교통정보제공의 교통안전효과를 분석하기 위하여 현장조사를 통해 데이터를 수집하고 수집된 데이터에 대한 통계학적 검증을 시행하였다. VMS 교통정보제공 전 후의 차량주행특성은 교통정보제공 시 1차로와 2차로 모두 평균주행속도가 감소하고 차로 내 차량통행이 차로중심을 기준으로 통행하는 것으로 나타났다. 또한 VMS 교통정보제공이 교통안전효과에 미치는 영향을 분석하기 위하여 교통위험지역을 선정하고 구간을 통과하는 차량에 대한 확률분포를 Anderson-Darling Test를 통해 산정하여 비교하였다. 비교결과 1차로에서 VMS 교통정보제공으로 인해 교통안전효과가 차로양쪽 각각 0.69%와 7.07% 향상되는 것으로 나타났으며, 2차로의 경우 차로양쪽 각각 2.71%와 0.02% 향상되는 것으로 분석되었다. Recently ITS have been increasingly applied on the roads to resolve traffic problems. Especially, Variable Message Sign (VMS), which is the one of ITS for traffic management and traffic safety, can be used for providing information about road conditions, climate conditions. In this study, data acquisition and statistical analysis were conducted for estimating safety impacts of providing traffic information through VMS. As a result of analyzing traffic characteristics before and after providing traffic information through VMS, average travel speed was decreased and vehicles tended to drive on centerline of lanes in 1st and 2nd lane after providing traffic information through VMS. Also, in order to analyze safety impacts of provided VMS traffic information, traffic safety hazard zone was established in each lane and probability distributions of passing traffic on the study area was estimated through Anderson-Darling Test. As a result of this, safety impacts of VMS traffic information in 1st lane could, on average, increase in left and right side of the lane by 0.69% and 7.07%, respectively. In case of 2nd lane, safety impacts could, on average, increase in left and right side of the lane by 2.71% and 0.02%, respectively.

상완골 골절에 동반된 요골 신경 마비 환자에서 초음파 검사의 유용성 - 술기 보고 -

이상혁,성창민,박형빈,Lee, Sang-Hyuk,Sung, Chang-Min,Park, Hyung-Bin 대한정형외과초음파학회 2012 대한정형외과 초음파학회지 Vol.5 No.1

상완골 골절에 동반된 요골 신경 마비는 전체 상완골 골절의 약 10%에서 발생하는 것으로 보고되고 있으며, 상완골 골절 수술과 관련하여 발생하는 의인성 요골 신경 마비는 10~20%로 알려져 있어 임상에서 흔히 경험하게 된다. 상완골 골절에 동반된 원발성 요골 신경 마비나 의인성 요골 신경 마비가 발생한 경우 요골 신경이 단열된 것인지 아니면 주위 구조물에 압박된 것인지 등의 요골 신경의 해부학적 상태의 평가는 자연회복을 기다릴 것인지 아니면 수술적 탐색술을 실시할 것인지 여부를 결정하는데 중요하다. 저자들은 상완골 골절에 동반된 원발성 요골 신경 마비 1예와 수술과 관련한 의인성 요골 신경 마비 1예를 초음파 검사로 신경의 해부학적 상태를 확인한 후 신경의 단열이 있었던 1예는 비복신경 이식술을 시행하였고, 신경유착이 있었던 1예는 신경박리술을 시행하여 만족할 만한 임상결과를 얻었기에 초음파를 이용한 요골 신경 검사를 중심으로 문헌 고찰과 함께 보고하고자 한다. Primary radial nerve palsy occurs in association with approximately 10% of humerus shaft fractures. Secondary radial nerve palsy, which is iatrogenic, occurs in association with approximately 10% to 20% of humerus shaft fractures. Whether the radial nerve palsy is caused primarily by the fracture or secondarily by the surgery, it is necessary to determine whether the radial nerve is being disrupted or compressed by the surrounding structures. This evaluation will dictate whether to await natural recovery or to perform surgical exploration. The current authors report one case of primary radial nerve palsy, due to the humerus fracture, and one case of secondary radial nerve palsy, associated with the osteosynthesis procedure. In both patients, the radial nerve was assessed for anatomical integrity with ultrasonography. Nerve disruption was found in one patient, and a sural nerve graft was performed. Nerve adhesion was found in the other patient, and neurolysis was performed. In both cases, the clinical results were satisfactory. This report focuses on the usefulness of ultrasonography in radial nerve assessment in patients with radial nerve palsy.

경부식도암 및 하부인두암에서 근치적 전후두인두식도절제술 후 위를 이용한 재건술의 의의

이상혁,이상훈,윤호영,김충배,Lee, Sang-Hyuk,Lee, Sang-Hoon,Yoon, Ho-Young,Kim, Choong-Bai 대한위암학회 2007 대한위암학회지 Vol.7 No.4

목적: 하부인두암 및 경부식도암 환자에서 근치적 전인두후두식도절제술시 위를 이용한 재건술 후 수술의 결과를 분석하고자 한다. 대상 및 방법: 1991년부터 2006년까지 하인두암 및 경부식도암에서 전인두후두식도절제술을 시행하였고, 재건술을 개흉술 없이, 경열공적으로 위를 이용하여 하인두위 문합술을 시행한 23예를 대상으로 하였다. 수술 후 합병증에 대해서는 신체검사소견과 수술 후 시행한 식도조영술의 결과에 따라 분류하였고, 퇴원 후 외래추적조사 시 환자의 증상 및 신체검사소견상 협착이나 재발의 가능성이 있는 환자에서 시행한 흉부 X-선 검사, 식도내시경 및 식도조영술을 바탕으로 분석하였다. 결과: 수술 후 사망한 환자는 2예(8.8%)였으며, 4예(4.4%)에서 누출이 있었으나, 공장루를 통해 경장영양으로 해결되었으며, 협착은 없었다. 호흡기합병증은 폐렴 1예, 기흉 1예였다. 수술 후에 연하곤란은 없었으나, 2000년 이후 유분부성형술을 시행하지 않으므로, 일시적으로 정체증상을 호소한 환자가 1예 있었다. 결론: 하인두암이나 경부식도암에서 근치적 절제 후 위장관 재건술시 위를 이용하는 것은 충분한 길이를 얻을 수 있어, 원활한 혈액공급이 가능하여 조직괴사나 문합부 누출 및 협착 등의 합병증이 적으며, 술식의 시간이 빠르다. 또한 모든 문합이 경부에서 이루어지므로 문합부의 누출이 발생하더라도 쉽게 치료되어 수술 후 이환율과 사망률이 감소한다는 장점이 있다. Purpose: The aim of this study was to analyze the post operative outcome of reconstruction with using the stomach after performing total pharyngolaryngoesophagectomy in patients with hypopharyngeal cancer or cervical esophageal cancer. Materials and Methods: We conducted a retrospective chart review of 23 patients who underwent gastric pull up for esophageal substitution at the Department of Surgery, Yonsei University College of Medicine, between January 1991 and December 2006. All the patients had transhiatal esophagectomy performed without thoracotomy. Results: There were seventeen males and six females with a median age of 58.1 years (range: 40-70 years). 19 cases were hypopharyngeal cancer, 13 cases had cancer in the pyriform sinus, 15 cases had cancer in the postcricoid area and one case had cancer in the glottic area. The rest were cervical esophageal cancers. The pathologic result was squamous cell carcinoma in all cases. The median total follow-up period was 33 months (range: 1-62 months) and there were two (8.6%) postoperative deaths: one was due to carotid rupture and the other was due to hepatic failure with liver metastasis. The complications were leakage in 1 patient (4.4%), pneumothorax in 1 patient (4.4%) and pneumonia in 1 patient (4.4%). Conclusion: The use of stomach for esophageal reconstruction has many benefits for treating hypopharyngeal cancer or cervical esophageal cancer, So, we made sure there was a sufficient length for the anastomosis after pharyngolaryngoesophagectomy and a rich blood supply from the stomach. There was a low incidence of the leakage at the anastomotic site, along with a low incidence of stenosis and bleeding.

후두 내시경의 진단적 역할

이상혁,Lee, Sang-Hyuk 대한후두음성언어의학회 2010 대한후두음성언어의학회지 Vol.21 No.1

Diagnosis of a patient with dysphonia begins with a thorough history and physical examination. Larynx can be visualized either indirectly or directly with a rigid or flexible laryngoscope. One notable limitation of simple indirect laryngoscopy is that the examination dose not yields a recordable and reproducible image of the larynx and vocal tract. And unaided human eye is unable to visualize the vibratory patterns of the true vocal cord during phonantion. When available, stroboscopy provides useful information regarding vocal told closure, vibration, and mucosal wave which is useful to decide between microsurgery, vocal reeducation or a combined treatment Even there are some limitations, recognition of the advantages and disadvantages of stroboscopy allows for optimal appreciation and stroboscopy remains an essential diagnostic tool in the assessment of dysphonia.

양성 성대 병변의 비수술적 치료

이상혁,Lee, Sang Hyuk 대한후두음성언어의학회 2015 대한후두음성언어의학회지 Vol.26 No.2

Benign vocal fold lesions, such as vocal nodules, polyps and Reinke's edema, usually result from chronic voice overuse. Conservative management such as voice therapy and pharmacotherapy are used as the primary treatment techniques. The main purpose of voice therapy is to identify and reduce voice misuse to achieve the optimal voice. But complete resolution may not be possible in all patients after voice therapy. Furthermore, some patients with voice-related occupations, voice rest and voice therapy are sometimes difficult, which makes it hard to carry out the treatment. When conservative therapy is ineffective, laryngeal microsurgery can be performed under general anesthesia. However, potential complications following laryngeal suspension and violation of the layered structure of the vocal fold during surgery should be considered before surgery. In recent decades, emerging literatures have demonstrated the potential usefulness of vocal fold steroid injection as an alternative treatment option for benign vocal fold lesions. The most advantageous feature of vocal fold steroid injection is the maintenance of regional anti-inflammatory effects while preventing the potential systemic adverse effects of the steroid. Many non-surgical treatment methods can be conducted using different approaches in the office setting. It can be applied as an alternative treatment modality for the management of various benign vocal fold lesions.

신뢰성 있는 정보의 추출을 위한 퍼지집합의 유사측도 구성

이상혁,Lee Sang-Hyuk 한국통신학회 2005 韓國通信學會論文誌 Vol.30 No.9C

모호함의 측도를 위하여 퍼지 엔트로피와 거리측도 그리고 유사측도와의 관계를 이용하여 새로운 퍼지 측도를 제안하였다. 제안된 퍼지 엔트로피는 거리측도를 이용하여 구성된다. 거리측도는 일반적으로 사용되는 해밍 거리를 이용하였다. 또한 집합사이의 유사성을 측정하기 위한 유사측도를 거리 측도를 이용하여 구성하였고, 제안한 퍼지 엔트로피와 유사측도를 증명을 통하여 타당성을 확인하였다. We construct the fuzzy entropy for measuring of uncertainty with the help of relation between distance measure and similarity measure. Proposed fuzzy entropy is constructed through distance measure. In this study, the distance measure is used Hamming distance measure. Also for the measure of similarity between fuzzy sets or crisp sets, we construct similarity measure through distance measure, and the proposed 려zzy entropies and similarity measures are proved.

후두 결핵의 후두 내시경 소견과 임상 양상 분석

이상혁,이승석,이노희,반재호,이경철,진성민,Lee, Sang-Hyuk,Lee, Seung-Suk,Lee, No-Hee,Ban, Jae-Ho,Lee, Kyung-Chul,Jin, Sung-Min 대한후두음성언어의학회 2006 대한후두음성언어의학회지 Vol.17 No.1

Background and Objectives: There has been a gradual decline in the incidence of laryngeal tuberculosis due to effective an-tituberculous chemotherapy and improvement in the standard of living. During the last decade, however, the disease has changed its clinical pattern. We aimed to study a clinical and telescopic evaluation of laryngeal tuberculosis. Materials and Method: A retrospective clinical analysis was done for 16 patients who diagnosed laryngeal tuberculosis from January 2000 through December 2004. All patients had a complete clinical and laboratory work-up including telescopy, chest X-rays, sputum cultures, Tbc PCR(polymerase chain reaction). Laryngeal biopsies were performed in some cases. All the patients received proper antituberculous chemotherapy. Results: The patients age ranged from 21 to 59 with a mean age 43. The male to female ratio was 10:6. The prominent presenting symptom was hoarseness. The various telescopic findings were categorized: 7 patients showed ulcerative, 4 patients granulomatous, 3 patients ulcerofungative, 2 patients had nonspecific inflammatory lesions. Involving sites were true vocal cord most commonly in 12 patients. Three of 16 patients had normal chest X-ray fmding. Among 16 patients, 4 patients showed positive response for AFB stain, 13 patients showed positive for Tbc PCR. Biopsy was done for 3 patients who were not confirmed in initial tuberculous test. All patients responded satisfactorily to antituberculous medication. Conclusion: The telescopic findings and clinical manifestations of laryngeal tuberculosis have changed and seemed to be different from those of classic reports. Thus, the clinicians who deal with the various symptoms and diseases should be aware of the existence of laryngeal tuberculosis and the changing patterns of the disease.

인공습지 형태에 따른 비점오염저감효율 분석

이상혁,김이형,조혜진,Lee, Sang Hyuk,Kim, Lee Hyung,Cho, Hye Jin 응용생태공학회 2014 Ecology and resilient infrastructure Vol.1 No.2

비점오염저감시설에 대한 연구는 활발히 진행되고 있으나, 도로에 자연형 비점오염저감시설 설치시 비점오염저감효율에 대한 연구는 없는 실정이다. 본 연구에서는 도로에 설치된 여러 종류의 인공습지에 대한 비점오염 저감효율을 모니터링과 유량가중평균농도법을 이용하여 분석하였다. 분석결과, 인공습지는 일반적인 오염물질인 TSS, COD, BOD, TN, TP에 대한 저감효율은 비교적 우수한 것으로 나타났으며 중금속인 Cr, Zn, Pb의 제거효율은 낮거나 거의 없는 것으로 나타났다. Studies of non-point pollutant treatment facilities have widely been conducted for a decade, but natural non-point pollutant treatment facilities implemented on roads have not been carried out for the removal efficiency of non-point pollution sources. This study analyzed the removal efficiency of non-point pollution sources from constructed wetlands using monitoring and event mean concentration method. As a result of this study, removal efficiency of general non-point pollution sources as TSS, COD, BOD is relatively good, but removal efficiency of TN, TP, Cr, Zn, Pb is very small or nothing.

보툴리눔 독소의 약리

이상혁,이현섭,진성민,Lee, Sang Hyuk,Lee, Hyun Sub,Jin, Sung Min 대한후두음성언어의학회 2012 대한후두음성언어의학회지 Vol.23 No.2

Botulinum toxins are the most potent toxins known to mankind. Botulinum toxin acts by blocking the cholinergic neuromuscular or the cholinergic autonomic innervation of exocrine glands and smooth muscles. Seven distinct antigenic botulinum toxins (A, B, C, D, E, F and G) produced by different strains of Clostridium botulinum have been described and only A and B type of botulinum toxins were clinically used. Toxins were consisted of a heavy chain with a molecular weight of 100 kD and a light chain with a molecular weight of 50 kD. Toxins are bound with an astounding selectivity to glycoprotein structures located on the cholinergic nerve terminal. Subsequently light chain of toxin is internalized and cleaves different proteins of the acetylcholine transport protein cascade transporting the acetylcholine vesicle from the intracellular space into the synaptic cleft. After a decade of therapeutic application of the toxin, no anaphylaxis or deaths have been reported and systemic adverse effects have not been reported so far. However the toxin's immunologic properties can lead to the stimulation of antibody production, potentially rendering further treatments ineffective. Botulinum toxin is a safe and effective treatment. Use of botulinum toxin in clinical medicine has grown exponentially in recent years, and many parts of the human body are now being targeted for therapeutic purposes.