대상포진후 신경통에 적용한 경막외 Phenol 주입법

문봉기,서영선,윤덕미,오흥근,이석균,Moon, Bong-Ki,Seo, Young-Sun,Yoon, Duck-Mi,Oh, Hung-Kun,Lee, Suk-Kun 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.2

Postherpetic neuralgia is one of the most troublesome disease in pain clinic. Nine patients who suffered from postherpetic neuralgia for 1.5 to 8 month, has been treated with the epidural block for prognostic or therapeutic purpose. Epidural catheter was inserted as close to the involved neural roots as possible, and tip of epidural catheter was confirmed under fluroscopic guide. Epidural neurolysis was performed out intermittent injection of 1~3 ml of 6% phenol in saline and repeated 2~6 times over one or 7 days interval. Two patients reported satisfactory pain relief and 3 patients reported some pain relief. But 4 patients unchanged after phenol block. The overall duration of pain relief was not studied. Validity and safety of epidural phenol block was not confined. Further study will be necessary before application of epidural phenol block to postherpetic neuralgia.

방사선치료 안내동영상 제작

왕철환,강승희,문봉기,박동욱,원영진,박광현,김주현,방승미,Wang, Chul-Hwan,Kang, Seung-Hee,Moon, Bong-Ki,Park, Dong-Wook,Won, Yeong-Jin,Park, Kwang-Hyeon,Kim, Joo-Hyeon,Bang, Seung-Mi 한국의료질향상학회 2013 한국의료질향상학회지 Vol.19 No.1

Objectives: This video has been produced to provide better awareness for our patients about radiotherapy treatment for anxiety and stress. This video will give inexperienced patients a better understanding of the processes and expectations of the radiotherapy. We have produced a radiotherapy guidance video regarding work flow and a method of radiotherapy to relieve anxiety and stress. It also improves patients satisfaction and understanding of radiotherapy to provide a high-quality health care for radiotherapy patients with indirect experience. Methods: We have evaluated the effectiveness of the video compared to our existing verbal method. See below for the evaluation criteria; 1) Patients satisfaction rate of guidance 2) a comparison of understanding of radiotherapy 3) a comparison of a time of education for patients 4) a researching of an incidence rate of radiotherapy. Results: When compared to the verbal explanation the patients had a increased level of understanding of the radiotherapy treatment. The time to educate patient was decreased and the level of incidents during the treatment was decreased due to the patient having a better understanding of the whole process. Conclusion : In conclusion, the audiovisual education increased the understanding of radiotherapy for patients compared to verbal education. The video also helped patients to cooperate in treatment room so we can provide premium radiotherapy treatment. By reducing the treatment time and education processa we improved the patients overall experience.

두경부암 방사선치료 시 선량 균일도 향상을 위한 Thermoplastic 구강 보상체의 개발

최준용,원영진,박지연,김종원,문봉기,윤형근,문수호,전종병,서태석,Choi, Joon-Yong,Won, Young-Jin,Park, Ji-Yeon,Kim, Jong-Won,Moon, Bong-Ki,Yoon, Hyong-Geun,Moon, Soo-Ho,Jeon, Jong-Byeong,Suh, Tae-Suk 한국의학물리학회 2012 의학물리 Vol.23 No.4

두경부암 방사선치료 시 공동 경계면 및 주변 치료 부위의 선량 균일도 향상을 위하여 조직 등가의 thermoplastic 구강 보상체를 개발하였다. Thermoplastic의 유용성 평가를 위해, 기존에 사용해 오던 치과용 인상재료인 paraffin, alginate, 그리고 putty로 제작한 각 구강 보상체의 물성 및 선량 분포 향상도를 비교하였다. 물성 평가에는 강도 평가(압축 실험, 낙하 실험)와 자연변형도(시간에 따른 체적 변화) 평가를 수행하였으며, 개발한 선량 검증용 팬톰에 삽입한 유리선량계와 Gafchromic EBT2 필름을 이용하여 표면선량, 공동 경계면 선량 및 빔 측면도를 측정하여 전달 선량을 평가하였다. 두 달간 각 구강 보상체의 자연변형도 평가하였을 때, alginate는 수분증발로 최대 80% 체적 변화를 보였으나, thermoplastic을 포함한 나머지 조직 등가 물질은 체적 변화가 3% 미만으로 나타났다. 강도 평가 중 5회 반복한 1.5 m 높이의 자유 낙하실험에서 paraffin은 충격에 의하여 파손이 발생되었으나, thermoplastic은 낙하에 의한 파손이 발생되지 않았으며, 압축 강도 실험에서도 paraffin에 비하여 8배 이상의 높은 힘에서도 파손되지 않았다. 유리선량계를 이용한 선량 검증 결과, 1문 조사 시 조직등가[약 80 HU (Hounsfield Unit)]의 thermoplastic은 동일한 처방 선량 전달 시 약 1,000 HU 이상의 값을 나타내는 putty에 비해 4% 낮은 출력계수(monitor unit) 전달로 약 4.9%의 낮은 표면 선량을 전달하였다. 또한 빔 입사 방향을 기준으로 할 때, 구강 통과 후 경계면의 빔 측면도에서 선량 균일도 평가를 위해 측정한 조사영역 편평도는 air, thermoplastic, putty에서 각각 11.41, 3.98, 4.30으로 나타났다. Thermoplastic 구강 보상체는 조직 등가 물질로 기존에 사용해오던 구강 보상체에 비하여 강도가 높고 물질 변형 확률이 적으며, 구강을 포함을 경계면 및 주변 부위에 균일한 선량 분포를 형성할 수 있으므로 균일한 처방 선량 전달 및 피부 선량 감소가 가능하다. Aquaplast Thermoplastic (AT) is a tissue-equivalent oral compensator that has been developed to improve dose uniformity at the common boundary and around the treated area during radiotherapy in patients with head and neck cancer. In order to assess the usefulness of AT, the degree of improvement in dose distribution and physical properties were compared to those of oral compensators made using paraffin, alginate, and putty, which are materials conventionally used in dental imprinting. To assess the physical properties, strength evaluations (compression and drop evaluations) and natural deformation evaluations (volume change over time) were performed; a Gafchromic EBT2 film and a glass dosimeter inserted into a developed phantom for dose verification were used to measure the common boundary dose and the beam profile to assess the dose delivery. When the natural deformation of the oral compensators was assessed over a two-month period, alginate exhibited a maximum of 80% change in volume from moisture evaporation, while the remaining tissue-equivalent properties, including those of AT, showed a change in volume that was less than 3%. In a free-fall test at a height of 1.5 m (repeated 5 times as a strength evaluation), paraffin was easily damaged by the impact, but AT exhibited no damage from the fall. In compressive strength testing, AT was not destroyed even at 8 times the force needed for paraffin. In dose verification using a glass dosimeter, the results showed that in a single test, the tissue-equivalent (about 80 Hounsfield Units [HU]) AT delivered about 4.9% lower surface dose in terms of delivery of an output coefficient (monitor unit), which was 4% lower than putty and exhibited a value of about 1,000 HU or higher during a dose delivery of the same formulation. In addition, when the incident direction of the beam was used as a reference, the uniformity of the dose, as assessed from the beam profile at the boundary after passing through the oral compensators, was 11.41, 3.98, and 4.30 for air, AT, and putty, respectively. The AT oral compensator had a higher strength and lower probability of material transformation than the oral compensators conventionally used as a tissue-equivalent material, and a uniform dose distribution was successfully formed at the boundary and surrounding area including the mouth. It was also possible to deliver a uniformly formulated dose and reduce the skin dose delivery.

임상연구 : Remifentanil이 Propofol의 진정효과에 미치는 영향

박성용 ( Sung Yong Park ),민상기 ( Sang Ki Min ),문봉기 ( Bong Ki Moon ),채윤정 ( Yun Jeong Chae ),정원호 ( Won Ho Jeong ),김종엽 ( Jong Yeop Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2

Background: General anesthesia is a balance between hypnosis and analgesia. Remifentanil is often combined with propofol to both induce and maintain total intravenous anesthesia. This study evaluated the effect of remifentanil on the propofol requirements for a loss of consciousness. Methods: Forty adult patients with ASA 1 or 2 were enrolled in this study. The patients were randomly given either saline or remifentanil before the induction of anesthesia with an infusion of propofol, 15 mg/kg/h. In the remifentanil group, all the patients received a computer controlled infusion of remifentanil with a effect site concentration of 4 ng/ml. The times required for the patient to lose consciousness, the propofol requirements and the bispectral index at the loss of consciousness to verbal commands were recorded. Results: In the remifentanil group, loss of consciousness was attained significantly faster and with lower propofol doses than in the saline group. The bispectral indices were significantly higher at loss of consciousness in the remifentanil group. Conclusions: A remifentanil infusion before the induction of propofol anesthesia significantly reduces the propofol requirements for the loss of consciousness. Remifentanil enhances the hypnotic effect of propofol. (Korean J Anesthesiol 2006; 51: 147~50)

슬관절 전치환술을 받는 환자에서 진정 동안 발생한 기도 폐쇄가 수축기 혈압과 중심정맥압에 미치는 영향

박관식 ( Kwan Sik Park ),김대희 ( Dae Hee Kim ),문봉기 ( Bong Ki Moon ),박용덕 ( Yong Duck Park ),채윤정 ( Yun Jeong Chae ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1

Background: Severe respiratory variations of systolic arterial and central venous pressure (CVP) may increase the risk of embolic event in orthopedic patient. As airway obstruction during sedation can cause this respiratory variation, we evaluated the degree of variations of systolic blood (SBP) and CVP during airway obstruction period. Methods: Fifteen females who had obstructed airway during total knee replacement (TKR) were included for the study. After regional anesthesia were established, SBP and CVP variations were analyzed according to the three periods; baseline, obstruction, and airway, respectively. Calculated CVP variables were similar to SBP variables as below: ΔSBP=Exp(max) (maximal value at expiration)-Insp(nadir) (minimal value at inspiration), %ΔSBP=(ΔSBP/Exp(max))×100. The frequencies of pulsus paradoxus (PP) and negative inspiratory CVP (NIC) were also measured. Results: At obstruction period, ΔSBP was 21.7 mmHg and 93.3% of patient had PP. Also, ΔCVP was 19.3 mmHg and 100% of patient showed NIC. %ΔCVP (140%) was larger than %ΔSBP (16%). And ΔCVP was inversely correlated with baseline and obstruction SBP and %ΔCVP was also inversely correlated with baseline CVP at obstruction period. Conclusions: During airway obstruction in sedated TKR patients, variations of CVP are larger than those of SBP. So we have to monitor CVP continuously as well as SBP so as not to increase the possible risk of respiratory of variation. (Korean J Anesthesiol 2009; 57: 38~43)

임상연구 : Isoflurane 흡입마취 동안 아산화질소가 뇌 엔트로피에 미치는 영향

박관식 ( Kwan Sik Park ),박종국 ( Jong Cook Park ),문봉기 ( Bong Ki Moon ),이숙영 ( Sook Young Lee ),김진수 ( Jin Su Kim ),노현주 ( Hyun Ju No ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5

Background: The bispectral index has limitations in describing the exact depth of anesthesia during nitrous oxide inhalation. This study examined the effect of nitrous oxide on the cerebral entropy measured using an entropy module (M-ENTROPY Module S/5(R), Datex-Ohmeda division, Instrumentarium Corporation, Helsinki, Finland) during the stable anesthetic period with isoflurane inhalation. Methods: Sixty ASA 1 or 2 adult patients were randomly allocated to three groups. During the stable maintenance period after the skin incision, the baseline entropy values (response entropy, RE; state entropy, SE) were recorded at 2.5 minutes intervals over a 20 minute period on a single frontal channel at 0.9% end-tidal isoflurane. After this, medical air was used continuously (group C) or replaced with nitrous oxide at 40% (group L) or 60% (group H) with continuous hemodynamic and entropy values monitoring. Each of the variables was recorded and analyzed at 2.5 minutes intervals over a 20 minute period. Results: Average values (mean ± SD) of the RE and SE during experimental period were lower in group H (29.2 ± 12.3 and 28.5 ± 11.7, respectively) than group L (33.9 ± 7.3 and 33.0 ± 7.3, respectively) and the averaged values were lower in group L than in group C (46.6 ± 14.8 and 45.5 ± 14.2, respectively). The percent reduction was larger in group H (42.1 ± 14.2 and 38.7 ± 16.5, respectively) than in group L (25.3 ± 15.1 and 24.4 ± 14.9, respectively) and the percent reduction was larger in group L than in group C (P < 0.01). Conclusions: Added nitrous oxide during the anesthetic maintenance period with isoflurane decreases the level of cerebral entropy. (Korean J Anesthesiol 2007; 52: 543~9)

뇌종양에 대한 각성하 개두술 고찰

김지헌 ( Ji Heon Kim ),조경기 ( Kyung Gi Cho ),문봉기 ( Bong Ki Moon ),김혁준 ( Hyeok Joon Kim ),정영선 ( Young Sun Chung ),신용삼 ( Yong Sam Shin ),안영환 ( Young Hwan Ahn ),윤수한 ( Soo Han Yoon ),조기홍 ( Ki Hong Cho ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

Awake craniotomy is a kind of operation which can be used in the case of the mass adjacent eloquent area. In this report, we explain the usefulness of awake craniotomy in the case of declining lung functions as well as the eloquent area. Methods:Awake craniotomy has been performed on fifteen from July 1999 to May 2002. Perioperative neurological state and their changes were evaluated in all patients. Results:The 15 patients who had undergone the surgery were satisfied with the results of their operations. The mean ages were 50.2. Male to female ration was 8:7. Tumors were located in eloquent area such as motor cortex in 8 patients, speech area in 4 and thalamus in 1. Mean period of post ICU staying was 32.53 hours, mortality rate was 0% and two patients developed new neurological deficit. Also, three patients who were inadequate to general anesthesia because of old age and declined lung function have excellent results. We can reduce neurological deficit and make ICU care time shorterper with awake craniotomy. Conclusion:Awake craniotomy is useful operation in the cases of the mass located in the eloquent area and inadequacy to general anesthesia.

실험연구 : 백서 피질 신경원 혼합배양 모델에서 α-amino-5-methyl-4-isoxazolepropionate로 유도된 뇌독성에 대한 Propofol의 효과

서명신 ( Myoung Sin Seo ),박성용 ( Sung Yong Park ),김계숙 ( Kye Sook Kim ),문봉기 ( Bong Ki Moon ),김진수 ( Jin Soo Kim ),이숙영 ( Sook Young Lee ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5

Background: The pattern of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-mediated neurotoxicity (necrosis vs apoptosis) and the neuroprotective effect of propofol on AMPA-mediated neurotoxicity are still unclear. Methods: Thirteen-day-old primary rat mixed cortical cultures were used. To measure the neuroprotective effect of propofol, AMPA (50 μM), AMPA (50 μM) plus propofol (0.1, 1, 25, 50 μM), AMPA (50 μM) plus DMSO, propofol (50 μM) and DMSO were administered (n=45). Seventy-two h later, surviving cells were counted using trypan blue staining and were converted to cell death rate (CDR). To measure the effect of propofol (50 μM) on AMPA (50 μM)-induced apoptosis, a triple stain was done. In a fixed field (×400), the number of neuronal cells stained by neuronal nuclei (NeuN) and Hoechst staining and apoptotic cells stained by terminal deoxynucleotidyl transferase mediated dUTP nick-end-labeling (TUNEL) assays were counted. Apoptotic cell rates (ACR) were also calculated. Statistical analyses were performed using one way-analysis of variance followed by Bonferroni`s test. P<0.05 was considered statistically significant. Results: AMPA (50 μM) stimulation demonstrated 49.3% CDR, and adding propofol 50 μM decreased CDR to 29.4% (P<0.05). In the TUNEL assay, cells with no drug treatment demonstrated 12.3% ACR and 50 μM AMPA increased ACR to28% (P<0.05). Adding 50 μM propofol to AMPA decreased the ACR to 20.1% (P<0.05). Conclusions: Propofol (50 μM) had neuroprotective effects against AMPA (50 μM)-induced cell death by reducing apoptosis. (Korean J Anesthesiol 2008;55:607~12)

마취영역에서의 아포토시즈(Apoptosis)

문봉기 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.5

혈관사이세포 단백합성기구의 미세구조에 미치는 Nocodazole의 영향

문봉기,박정현,이융창 대한해부학회 1995 Anatomy & Cell Biology Vol.28 No.3