일반외과 영역에서 염증성 질환에 대한 Carumonam sodium의 임상효과 및 안전성 평가

배진선,신홍식 최신의학사 1993 最新醫學 Vol.36 No.4

골격성 Ⅱ급 부정교합자의 악교정 수술 후 설골의 위치와 상기도 변화에 관한 연구

배진성,김경호,박형식,허종기,박광호 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

OSAS(obstructive sleep apnea syndrome) is becoming more and more of importance nowadays. Therefore the study concerning OSAS is very important. Most of the studies which have been reported were comparison of upper airway size and change of skeletal class Ⅰ group and skeletal class Ⅲ group respectively. But, most of the showing OSAS have pharyngeal narrowing combined with more or less distinct maxillary and mandibular deficiency. Therefore the aim of this study is to see posterior airway space and hyoid bone position in patients affected by class Ⅱ malocclusion and treated with orthognathic surgery. we measured the lines between selected upper air way landmarks on lateral cephalometric x-ray films of skeletal class Ⅱ 30 persons who had not been operated yet, were within 2 weeks after operation, were 6 months after operation. And we compared them respectively and analyzed them with pairing t-test, pearson correlation coefficient and multiple regression analysis. The results were as follows. First of all, skeletal class Ⅱ group was increased in all the level of PAS, especially PAS(MK) and PAS related to hyoid bone(H-phW, H-PhW(Me-H)) was significantly decreased within 6 months after operation but that was larger than preoperation. And then the PAS was increased after mandibular advancement surgery. While there was no significant correlation between PAS and surgical methods, there was statistical significance between PAS and a number of surgical movement. At last, the hyoid bone was advanced within 2 weeks after operation but relapsed within the follow up period. In the end of the study, it was turned out that PAS was always wider without distinction of the region after the operation and that there was significant correlation between the moving volume of hard tissues and the changing quantity of PAS( ; how much PAS was changed according to the moving degree of hard tissues). After this, to be based on the study, I consider that OSAS demands further study and that it is necessary to do more practical applications to the patients.

위암환자에서 수용성 Intercellular Adhesion Molecule-1의 의의

배진선,송인상,김완식 한국의학사 1999 診斷과治療 Vol.19 No.8

하악 시상골 절단술 후 고정 방법에 따른 회귀 성향에 대한 비교 연구

배진오,이동근,오승환,신기영,장관식 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.2

Objective : To compare two different methods of rigid fixation in postoperative stability after mandibular setback, Material and Methods : 28 patients with Class III malocclusion were treated by bilateral sagittal split ramus osteotomy(BSSRO) and mandibular setback were selected for this study. Group A(n=14) had the bone segments fixed with monocortical miniplate on the lateral side of the mandibular body and Group B(n=14) had three noncompressive bicortical screw inserted at the genial area through a transcutaneous approach. Cephalograms were taken preoperatively, postoperatively within 1 weeks and at a follow-up period (mean 8.9 months after surgery) and the amount of setback and postoperative change were measured. Results : Postoperative relapse between two groups was minimal in setback of the mandible. Statistical analysis showed no significant difference in postoperative relapse. Conclusion : This study suggests that both methods of skeletal fixation investigated give comparable postoperative stability and their use in mandibular setback appears to be a fairly stable clinical procedure.

두개저 골절 환자의 임상적 고찰

김한식,목진호,이규춘,이영배 동국대학교 경주대학 1997 東國論集 Vol.16 No.2

저자들은 최근 2년간 본원 신경외과에 입원 치료 받았던 두부외상 환자 중 자료 분석이 가능했던 119례의 두 개저부 골절 환자를 대상으로 임상 분석하여 다음과 같은 결론을 얻었다. 두부외상후 두개저 골절의 발생 빈도는 34%로 남녀 발생비는 5 : 1이었고, 활동기 연령인 20∼59세가 70.6%를 차지 하였다. 원인으로는 교통사고가 56.3%로 가장 많고 추락, 산재, 낙상, 구타 순이었으며, 내원당시 환자상태는 경증뇌손상(GCS 13-15)이 64.7%, 중증 뇌손상(3∼8) 21.8%, 중등도 뇌손상(9∼12) 13.5% 순이었고 예후도 GCS가 높을수록 양호하였다. 임상소견은 뇌척수액 비루(43.7%)가 가장 흔하고 비루(31.9%), 안와부 반상출혈(31.1%), 기뇌증(26.1%), 청각소실(18.5%)등이었다. 뇌척수액루의 지속 기간은 87.7%가 7일 이내였고 보존적 치료로 93.9%가 해결되었다. 2∼4주 지속된 경우는 요추천자 배액술, 4주 이상된 경우는 수술을 시행하였다. 뇌신경 손상은 안면신경마비가 31.7%로 가장 높았고 발현 시기는 지연성 마비가 69.2%, 조기마비가 30.8%였다. 뇌막염의 발생 빈도는 5.9%로 모두 뇌척수액루가 1주 이상 지속된 경우였고, 항생제 투여군과 비투여군의 뇌막염 발생율은 각각 6.1%와 4.8%로 항생제가 감염율을 낮추지는 못했다. 119 consecutive cases with basal skull fractures out of 343 head injuried patients who were treated in Pohang Hospital from July 1995 to July 1997 were analysed. The authors reviewed the clinical features, radiologic findings, complications and outcomes. Most of the patients(70.6%) were between 20 and 59 years old. The basal skull fractures were more common in men than women-the ratio being 5 : 1. The cause of BSF were traffic accident(56.3%), fall down, work related, silp down, and assults in decreasing order of frequency. The outcome of treatment wee related to initial GCS(Glasgow coma scale) of patients. The severity of head injury were mild(GCS13-15)-64.7%, Moderate(GCS9-12)-13.5%, and severe(GCS3-8)-21.8%, The most common feature of BSF were rhinorrhea(43.7%), otorrhea(31.3%), raccoon's eye(31.1%), pneumocephalus(26.1%), hearing disturbance(18.5%). Most of CSF leakage(86.7%) were noted within 24hours after injury and most of leakage(93.9%) were ceased by conservative management within 2 weeks, but one case that did not respond to conservative and lumbar drainage required operative repair. The facial nerve(31.7%) was the most frequently involved cranial nerve followed by vestibulocochlear and optic nerve. The onset of facial palsies were immediate in 30.8% and delayed 69.2%. The incidence of meningitis was 5.9% and the prophylactic antibiotics had no beneficial effect in reducing the infection rate.

두부외상후 생존기간에 영향을 주는 요인분석

목직호,김한식,이규춘,이영배 동국대학교 경주대학 1997 東國論集 Vol.16 No.2

1995년 7월부터 1997년 7월까지 최근 2년간 본원 신경외과에 입원한 343례의 두부손상 환자중 사망한 25례를 조기사망군(7일이내)과 후기사망군(7일후)으로 분류하여 분석해본 결과 7.3%의 사망률을 보였으며 남자 사망자는 여자에 비해 3.2배였으며, 연령 별로는 조기사망군은 40대이상에서 많았고 후기 사망군은 60대 이상의 고령에서 다소 많았다. 조기사망군에서는 낮은 GCS, 비정상적인 동공반사 반응, 타장기 손상, 저혈압, 저산소증, 고혈당, 심한 정중전이, 뇌실압박, 두개골 골절, 개두술의 빈도가 높게 조사되었다. 이송시간은 조기사망군에서 1시간 이내에 도착한 경우가 많아 신속한 후송이 이루어졌다. 한편 후기사망군에서는 저이산화탄소혈증, 빈혈, 고나트륨혈증등이 높게 조사되었다. 사인은 조기사망군에서 1차성두개강내 병변 및 저혈량 등이 많았고 후기사망례는 폐렴, 성인성 호흡곤란 증후군, 외상후성 뇌경색증 등이 주요 사망 원인이었다. 따라서 생존기간별로 위험도가 높은 요소를 찾아 그에 대한 적극적인 치료를 하는 것이 두부 손상으로 인한 사망률을 개선하는데 바람직한 것으로 생각된다. We present a study the variable factor in the early(within one week) and late death(after one week) after head injury. The multiple factors were analysed on the clinical, imaging, and laboratory characteristics of 25 patients who were dead among 343 head injured persons during recent 2 years form July, 1995 to July, 1997. The mortality rate was 7.3% and the ratio of male to female was 3.2 to 1. The early death were younger than late death(5th decade vs 7th decade). Mechanism of injury were motor vehicle accident(64%), followed by work-related, slip and fall, and unknown. The early death had a higher percentage of low GCS score, abnormal pupil reflex, other associated injury, hypotension, hypoxemia, hyperglycemia, midline shift, ventricle compression, skull fracture, and craniotomy compared with the late death. On the other hand, the late death had a higher incidence of hypocarbia, anemia, and hypernatremia than the early death. The main causes of death were primary intracranial lesions and hypovolemia in the early death and pneumonia, ARDS, and posttraumatic cerebral infarction in the late death.

Vertebrobasilar Dolichoectasia 4례 : 증례보고 A Case Report

목진호,김한식,이규춘,이영배 동국대학교 경주대학 1998 東國論集 Vol.17 No.1

Dolichoectasia란 혈관이 연장되고 방추상으로 팽창된 것을 말하며 두경부 혈관에서는 추골-기저동맥과 내경동맥에 주로 발생하며 중대뇌동맥이나 전대뇌동맥에는 드물게 발생한다 Vertebrobasilar dolichoectasia는 대부분 무증상이지만, 일분 환자에서는 뇌간이나 뇌신경들을 압박하거나 뇌허혈을 유발하여 증상을 나타낼 수 있고 임상증상에 따라 1) ischemic symptom 2) cranial nerve compression symptom 3) pseudotumor symptom 으로 구분할 수 있다. 그러나 임상경과중 반복적인 뇌 허혈증상 또는 뇌간 경색증을 유발하여 심각한 임상경과와 불량한 예후를 나타낼 수도 있다. 따라서 Vertebrobasilar dolichoectasia로 진단된 환자에서는 적극적으로 고혈압을 치료하며, 임상증상이 없더라도 항응고 제제나 항혈소판 제제를 투약하며 주의 깊게 관찰하여야 할 것이다. 자들은 일과성 허혈성 발작이나 뇌신경기능 장애를 보이는 Vertebrobasilar dolichoectasia 4례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The dolichoectasia of cerebral arteries is an uncommon entity and the term dolichoectasia (elongation-distention) has been used to describe these vessels, which are characterized by elongation and fusiform dilatation. The vertebrobasilar system and intracranial internal caroted arteries are more frequently involved and the diagnosis can be made by cerebral angiography, brain CT or brain MRI. It is generally asymptomatic, but may present with a variety of symptoms. Headache, cranial nerve paresis and cerebral ischemia are the most common clinical presentations. Cerebral ischemia, especially brain stem infarction, due to vertebrobasilar dolichoectasia is rare, but its development may be fatal. When the dolichoectasia is diagnosed by CT findings, even if it is clinically asymptomatic, it may be better to treat patients with medical therapy used to prevent ischemic stroke. We report four cases with vertebrobasilar dolichoectasia, all of them had ischemic symptoms and were treated with medical therapy.

석이로부터 분리한 페놀성 화합물의 phospholipase A_2 저해활성

김진우,송경식,유익동,장현욱,유승현,배강규,민태진 충남대학교 생물공학연구소 1997 생물공학연구지 Vol.5 No.-

호알카리성 진균 Cephalosporium sp. RYM-202가 생산하는 alkaline xylanase (CX-III)의 작용에 의해 xylan 기질로부터 생성되는 주요 가수분해 산물은 xylobiose와 중합도가 4 이상인 xylooligosaccharides이었다. 이 효소는 xylobiose에 대한 분해능을 가지고 있지 않지만 xylotriose로부터는 xylobiose를, xylotetraose로부터는 xylobiose와 xylotriose를 주산물로 형성하였다. 이러한 결과들은 CX-III가 transglycosidase 활성을 소유하는 전형적인 endo-type xylanase임을 보여준다. N-bromosuccinimide에 의한 CX-III의 화학적 변화 실험 결과 효소 1분자 당 2개의 tryptophan 잔기가 활성에 관여하는 것으로 나타났다. 그러나 iodoacetamide 및 diethylpyrocarbonate에 의한 효소활성의 저해효과는 나타나지 않음으로써 이 효소의 활성부위에 cysteine과 histidine 잔기가 필수적이지 않음이 확인되었다. The hydrolysis products formed from birchwood xylan by the action of an alkaline xylanase (CX-III) from alkalophilic Cephalosporium sp. RYM-202 were xylobiose and xylooligosaccharides polymerized with more than 4 sugar molecules. This enzyme was not active on xylobiose but readily attacked xylotriose accumulating xylobiose as a major product. The predominant end-products from xylotetraose by CX-III were xylobiose and xylotriose. These results indicate that the enzyme is typically endo-type xylanase possessing transglycosidase activity. Chemaical modification of CX-III with N-bromosuccinimide revealed that two tryptophan residues per molecule of CX-III were essential for its catalytic activity on xylan. On the other hand, iodoacetamide and diethylpyrocarbonate did not influence the activity of the enzyme, suggesting that cysteine and histidine residues are not involved in the active site of this alkaline xylanase.

완속여과 시스템에서 입자 제거와 손실수두(headloss)의 관계

신승식,홍진아,전항배 충북대학교 건설기술연구소 2003 建設技術論文集 Vol.22 No.1

The operational performance of slow sand filters can be considerably improved by the application of a layer of non-woven synthetic fabric to the top surface of the sand media. This improvement is manifested in terms of an increased filter run time and the avoidance of headloss development within the sand media. The relationship between particulate removal and headloss development were investigated with two pilot-scale slow sand filters(filter A and filter B(ACF)) of which diameter was 140 mm and packed with sand in the depth of 850 ㎜. One of the filters was amended by covering the surface of slow sand filters with a ACF(activated carbon fiber) of which specific surface area was more than 1000 ㎡/g and thickness was 3 ㎜. Effective size and uniform coefficient of the sand medium was 0.31 ㎜ and 2.0 respectively. Initial filtration rate was 0.167 m/hr and the raw water turbidity and pH were in the range of 1.5-2.0 NTU, and 7.0-7.7, respectively. The particle removal efficiency of small than 2 ㎛ showed 86, 78% and greater than 3 ㎛ showed 96, 95% in the slow sand filter A and B(ACF), respectively. NPOC removed within upper 50 ㎜ depth and Schmutzdecke in slow sand filter B(ACF). Therefore, amended slow sand filter with non-woven fabric could reduce filter ripening time.

후두와 병변 수술의 발생한 경막하 긴장성 기두증

목진호,김한식,이규춘,박용석,이영배 東國大學校醫學硏究所 1999 東國醫學 Vol.6 No.-

긴장성 기두증은 신경외과영역에서 개두수술 후에 발생할 수 있는 드문 합병증으로 특히 만성 뇌경막하 혈종 제거수술이나 좌위에서 후두와 수술을 시행한 경우에 발생할 수 있다. 따라서 개두수술 후에 신경학적 증상의 악화가 있거나 수술 후 예상경과를 취하지 않는 경우에는 긴장성 기두증의 발생 가증성을 항상 고려하여야 한다. 긴장성 기두증의 발생기전은 물병을 거꾸로 세운 것과 같은 기전(Inverted pop-bottle mechanism)으로 뇌척수액이 누수된 만큼 공기방울이 경막하강으로 올라가 빈 공간을 메우는 것이다. 이와 같은 기전으로 두개강내로 들어간 공기가 일정한 압력을 가지게 되어 주변 뇌조직을 압박하여 신경학적 장애를 초래하게 된다. 뇌전산화 단층촬영을 이용하여 쉽게 진단이 가능하며 치료는 두개골 천공을 시행하여 두개강내 공기를 배기시켜 줌으로서 가능하다. 저자들은 복와위에서 후두와 병변 수술 후에 발생한 긴장성 기두증을 뇌전산화 단층촬영을 이용하여 진단하고 전두골을 천공하여 두개강내 공기를 배기시켜 치험하였기에 문헌고찰과 함께 증례를 보고하는 바이다. 중심단어:긴장성 기두증, 후두와 수술, 경막하강, 복와위 Tension pneumocephalus is a rare complication in neurosurgical operation and should be considered whenever a patient fails to recover as expected following surgery. The possible mechanism for the entry of air into the subdural space is analogous to the entry of air into an inverted soda-pop bottle. As the fluid pours out. air bubbles reach the top of the container, Computed tomography permitted rapid diagnosis including localization of the air, thus facilitating prompt treatment. Peaking of frontal lobe. mountain appearance of frontal lobe. and air densities at the cisterns are characteristic findings of' tension pneumocephalus on brain CT scan. This condition is easily diagnosed and treated using twist-drill aspiration. The authors describe a case of subdural tension pneumocephalus complicating the early postoperative course after posterior fossa surgery in the prone position.