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자궁경부상피내종양의 치료에서 환상투열요법 (LLETZ) 시행 후 잔류병변의 예측인자
김용범,박노현,이철민,김재원,송용상,강순범,이효표,김성일,심순섭 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.3
목적: LLETZ(Large loop excision of transformation zone)는 자궁경부상피내종양(CIN)의 정확한 진단목적 뿐만 아니라 치료목적으로도 사용되고 있다. 그러나 LLETZ 후 자궁경부내 잔류병변의 가능성 및 예측인자에 대하여 명확히 밝혀져 있지 않기 때문에, CIN 치료 방법으로서 LLETZ의 안정성, LLETZ 시술 후 어떤 경우에 자궁절제술 등의 추가 치료를 실시할 것인가에 대하여 논란이 있다. 따라서 본 연구에서는 LLETZ시술 후 잔류병변 여부를 예측할 수 있는 관련인자들을 확인하고 절단면 양성의 임상적 의의를 알아보고자 하였다. 연구방법: 1993년 8월부터 1995년 7월까지 서울대학교 산부인과에서 LLETZ 시행 후 자궁절제술을 시행한 133명을 대상으로 임상기록을 검토하였다. 잔류병변 양성이란 자궁절제술 후 최종병리학적 소견에서 CIN이나 침윤암 등의 잔류병변이 확인된 경우로 정의하였고, 잔류병변이 없는 경우를 LLETZ를 통한 치료에 성공한 것으로 하였다. 잔류병변의 존재 여부에 연령, 병변의 등급, 절단면의 상태 등의 인자들이 관여하는지 확인하였으며, 통계학적 분석 방법으로 Student t-test, χ2 test와 Fisher's exact test를 사용하였다. 결과: LLETZ 후 자궁절제술을 시행한 환자의 85.7%(114/133)에서는 잔류병변이 없었으나 14.3%(19/133)에서 잔류병변이 발견되었고 이 중 미세침윤암이 3례에서 확인되었다. 잔류병변이 없는 환자군의 평균연령은 42.5세(27-71세)인 반면 잔류병변이 있는 환자군의 평균연령은 49.1세(33-72)로서 유의하게 높았다(p=0.005). LLETZ 후 조직검사에서 절단면 음성인 군에서 잔류병변이 발견된 경우는 9.6%(9/94)이었고 절단면 양성인 군에서 잔류병변이 발견된 경우는 25.6%(10/39)로서 두 군간에 유의한 차이를 보였다(p=0.032). LLETZ 후 조직검사에서 CIN II인 군과 CIN III인 군에서 잔류병변이 발견된 경우는 두 군에서 모두 14.3%(2/14, 17/119)로서 두 군간에 차이가 없었다. 결론: LLETZ 후 절단면 양성 여부가 잔류병변의 존재 여부와 일치하지 않는 경우가 많으며, 폐경 이후의 연령이 많은 여성이나, 절단면 양성인 경우 등 잔류병변 양성 가능성이 높은 환자의 경우에는 보다 철저한 추적관찰 혹은 광범위 원추생검술이나 자궁절제술 등의 보다 적극적인 치료가 고려되어야 할 것으로 사료된다. Objective: Large loop excision of transformation zone(LLETZ) is gaining popularity as an alternative to other ablative or cone methods for the treatment of cervical intraepithelial neoplasia(CIN). The optimal management of CIN after LLETZ, however, remains controversial and the reliable predictors of residual disease after LLETZ have not been consistently identified. This study was performed to identify factors to predict residual disease after LLETZ. Methods: From August 1993 to July 1995, 133 patients who received subsequent hysterectomy after LLETZ in Department of Obstetrics and Gynecology at Seoul National University Hospital were retrospectively reviewed. Residual disease was defined as positive findings of CIN or further advanced findings in hysterectomy specimen. The age of patients, the severity of disease and the status of resection margin(RM) were analyzed for predictive values of residual disease. The Chi-square test, Fisher's exact test and Student t-test were used for statistical analysis. Results: The residual disease after hysterectomy was negative in 85.7%(114/133) and positive in 14.3%(19/133). Among 19 cases with positive residual disease, 3 cases were revealed to be microinvasive cervical cancer. The mean age of patients with no residual disease was 42.5 years(range; 27-71) and that of patients with residual disease was 49.1 years(range; 33-72). Nine out of 94 cases(9.6%) with negative RM and 10 out of 39 cases(25.6%) with positive RM in LLETZ had residual disease. Two out of 14 cases(14.3%) with CIN II and 17 out of 119 cases(14.3%) with CIN III in LLETZ had residual disease. The success of LLETZ which means no residual disease was influenced by the age of patients(p=0.005) and the status of resection margin of LLETZ(p=0.032). Conclusion: The negative resection margin in LLETZ does not always guarantee that there is no residual disease. Close preoperative workup and more aggressive treatment plan(wide conization or hysterectomy) should be considered in patients who has higher possibility of positive residual disease such as old age and positive resection margin in LLETZ.
신경섬유종증 환자에서 상완신경총 병변의 소견을 보인 척추 신경섬유종
양충용,박효인,박순아,박종태,정선관,신용일 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2
본 증례는 50세 여성의 제 1형 신경섬유종 환자로서 척추 신경섬유종에 의해 초기 상완신경총 병변 소견을 보였다. 약 4개월 동안 후경부통, 좌측 견관절, 좌측 상완의 마비를 보였으며, 초기 전기진단학적 검사상 경수 5번과 6번 신경근을 중심으로 쇄골상부 신경절전성 상완신경총 병변이 관찰되었다. 그러나, 액와 자기공명영상, 초음파검사, 단순 방사선검사, 골주사 등의 영상학적 검사에서는 심한 흉추 척추 전-측만증과 경수 뇌경막에 확장 소견을 제외하고는 상완신경총 병변의 소견은 관찰되지 않았다. 7개월경과 후, 좌측 상지 및 양측 하지의 근력 저하, 경수 4번이하의 감각 저하, 경도의 흉통을 동반한 호흡곤란이 진행되었다. 응급으로 시행된 경수 자기공명영상에서 좌측 경수 3번과 4번에 경막내 액와-속질의 신경종양이 진단되었다. 수술적 처치를 시행하였으며, 거시적 관찰상 척수 신경섬유종이 진단되었다. 급격히 진행하는 척수 신경섬유종은 초기에 상완신경총의 신경근 병변의 소견을 보일 수 있으므로, 신경섬유종증 환자에서 상완신경총 병변의 진단에 세심한 주의를 요한다. We observed a patient with symptom similar to brachial plexus lesion caused by spinal neurofibroma in a 50-year-old female with a history of neurofibromatosis-1(NF-1). She presented with posterior neck, left shoulder and left upper arm paralysis of 4 months duration. The initial electrodiagnostic study(EDS) revealed supraclavicular preganglionic brachial plexus lesion of mainly involved left C5 and C6 roots. However, radiological imagings including axillar MRI, ultrasonography, cervical plain radiography and bone scintigraphy showed no definitive brachial plexus disease except cervical dural dilation and severe thoracic scolio-Iordosis. On 7 months after the first admission, she had aggravated muscle weakness on the left upper arm and both lower extremities, sensory impairment below C4 and respiration difficulty with the chest pain. Emergency MRI showed intradural axillar-medullary neurogenic tumor at the left C3-C4. Subsequently, the patient was treated with surgical resection. Grossly specimen examination displayed the presence of a spinal neurofibroma. In rapidly progressing spinal neurofibroma represented firstly as root lesion of brachial plexus in EDS, the physician should pay scrupulous care to evaluate the cause.
양충용,이진훈,이서울,정복희,노상균,신용일 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2
저자들은 brodifacoum성분의 지속형 효과를 갖은 항응고제인 쿠마린계 살서제를 정확한 용량을 추정할 수는 없지만 다회의 약물 복용 17일 후 뇌실질출혈이 발생한 증례를 문헌 고찰과 함께 보고하는 바이다. 지금껏 쿠마린계의 지속형 항응고성 살서제의 약물 중독이 알려져 있다. 이러한 약물은 vitamin K₁ 2,3-epoxide 환원효소를 억제하여 vitamin K₁과 연속적으로 vitamin K₁ 의존성 응고인자 Ⅱ, Ⅶ, Ⅸ, Ⅹ의 합성을 억제하고 이로써 출혈 경향을 증가시킨다. 이 증례를 토대로 향후 출혈성 환자 특히 선행 질환이 없는 젊은 뇌실질출혈 환자에서 원인을 감별진단 함에 있어 환자의 약물 중독 가능성과 치료에 대한세심한 주의가 필요할 것으로 생각한다. Spontaneous intracerebral hemorrhage is one-tenth of all strokes and represents relatively high frequency and morbidity. Hypertension is the most common cause of spontaneous intracerebral hemorrhage and other causes are vascular malformation, intracerebral amyloid angiopathy, hemorrhagic infarction, blood diseases and drug abuse. Some peoples have the intoxication of drug such as long-acting anticoagulant of rodenticides, family of cumarin, that inhibit vitamin K₁ 2,3-epoxide reductase, the synthesis of vitamin K₁ and subsequently vitamin K₁ dependent clotting factors Ⅱ, Ⅶ, Ⅸ, and Ⅹ. Finally these make prolonged PT, INR and aPTT, which are prone to trigger bleeding tendency. We report a rare case of intracerebral hemorrhage maybe caused by after frequent intended ingestion of long-acting anticoagulant rodenticide(brodifacoum) for suicide.
최용,전일수,김명식 金烏工科大學校 産業技術開發硏究院 1999 産業技術開發硏究 Vol.15 No.-
CMOS Reference Voltage Generator(RVG) is designed to possible CMOS process without additional process steps. It is possible to compensate the temperature of RVG by using PTAT(proportional to the absolute temperature). Temperature compensation is profitable because ??(electron mobility) is used. When VDD sweeps from 3V to 7V, variation ratio of ?? is 0.3125mV/V. Also temperature variation ratio of ?? is -47.1ppm/˚C during sweeping from 0˚C to 100˚C The total current is 15.24μA, and the Power Consumption is 50.3μW.
구강에서 채취한 혐기성 세균에 대한 서양산 고추냉이(Horseradish, Armoracia rusticana) 뿌리 추출물의 항균효과
장용걸,박호원,신일식,이주현,서현우 大韓小兒齒科學會 2010 大韓小兒齒科學會誌 Vol.37 No.2
서양산 고추냉이 (Horseradish, Armoracia rusticana)의 주성분인 allylisothiocyanate(AIT)는 각종 세균에 대한 살균 효과로 주목받고 있다. 이전 연구들을 통해 구강내 다양한 세균 및 진균류에 대한 항균성이 입증되었으나 근단내 병소를 유발하는 혐기성 세균에 대한 연구는 미진한 실정이다. 본 연구에서는 사람의 근단 병소에서 직접 분리한 E. faecalis와 F. nucleatum에 대한 서양산 고추냉이 뿌리 추출물의 항균활성을 표준균주와 비교해보고 이를 대표적인 항균제인 클로르헥시딘과 비교하여 다음과 같은 결론을 얻었다. 1. 서양산 고추냉이 뿌리 추출물은 E. faecalis 임상 분리균주에 대하여 표준균주와 같거나 약간 높은 농도에서 항균효과를 나타냈고, 625.0~1,250.0 μg/ml의 농도에서 클로르헥시딘 (7.8~15.6 μg/ml)과 대등한 항균효과를 가지는 것으로 나타났다. 2. 서양산 고추냉이 뿌리 추출물은 F. nucleatum 임상 분리균주에 대하여 표준균주와 같거나 약간 높은 농도에서 항균효과를 나타냈고, 78.1~312.5 μg/ml의 농도에서 클로르헥사딘 (7.8~15.6 μg/ml)과 대등한 항균효과를 가지는 것으로 나타났다. 이번 연구로 표준균주 뿐만 아니라 구강에서 직접 분리한 혐기성 세균에 대한 서양산 고추냉이 뿌리 추출물의 항균성을 확인할 수 있었고, 추후 근관 세척제나 소독제로 서양산 고추냉이 뿌리 추출물을 이용할 수 있는 가능성을 보여주었다. Objective : The aim of this study was to determine the antimicrobical effect of horseradish root extracts against Enterococcus faecalis and Fusobacterium nucleatum isolated from oral cavity compared with reference strain, and compared with that of chlorhexidine. Method : Horseradish root extracts and chlorhexidine were sequentially diluted and tested against anaerobes(E. faecalis, F. nucleatum) isolated from children's oral cavity. The microbes were anaerobically incubated and the minimum inhibitory concentration(MIC) and minimum bactericidal concentration(MBC) were detected. Results: 1. Horseradish root extracts showed antimicrobial effect against E. faecalis isolated strain at same or slightly higher concentration compared with MIC of reference strain. 2. 625.0~1.250.0 ㎍/ml horseradish root extracts showed similar antimicrobial effect with chlorhexidine(7.8~15.6 ㎍/ml). 3. Horseradish root extracts showed antimicrobial effect against F. nucleatum isolated strain at same or slightly higher concentration compared with MIC of reference strain. 4. 78.1~312.5 ㎍/ml horseradish root extracts showed similar antimicrobial effect with chlorhexidine(7.8~15.6 ㎍/ml). Conclusions : The results of this study confirm that horseradish root extracts has antimicrobial effect against anaerobes isolated from oral cavity as well as reference strain. And we found the potential of horseradish root extracts as a canal irrigant or disinfectant.
문정미,소정일,김용권,류진호,허탁,서정진,민용일 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2
Post-traumatic fat embolism was first reported by Zenker in 1862, Von Bergmann reported the first clinical diagnosis of the fat embolism syndrome in 1873. Fat embolism has been associated with traumatic or non-traumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. The diagnosis of fat embolism syndrome is based on the patient's history, is supported by clinical signs of pulmonary, cerebral, and cutaneous dysfunction, and is confirmed by the demonstration of arterial hypoxemia in the abscence of other disorders. Two different mechanisms cause fat to embolize: direct entry of deposit fat into the blood stream and agglutination of endogenous or exogenous plasma fat. MRI can detect a cerebral fat embolism with a higher sensitivity than cerebral CT. We report a case of post-traumatic cerebral fat embolism without pulmonary involvement, and we present a review of the literature. A 16-year girl had a traffic accident and pelvic bone fracture. Forty eight hours later severe trauma become stuporous without a focal neurological deficit. The patient received supportive therapy, and her condition improved throughout her hospital course. She was discharged with good condition after a 30-day hospital stay.
신성호,박용원,김병일 明知大學校 産業技術硏究所 1997 産業技術硏究所論文集 Vol.16 No.-
When structures are constructed on soft ground, the counterplans have to be considered since the ground cylindrical slip failure by embankment, excessive settlement and lateral displacement cause the damage to structures and underground objects. In this study the lateral displacement are compared with the minimum safety factor that is considered by cylindrical slip failure for not-treated ground, Pack Drain treated ground and SCP treated ground. Numerical results show that the design of embankment by lateral displacement criteria is safer than that by safety factor of cylindrical failure. In considered larger than 1.8. when an important structure is designed, allowable lateral displacement for design of embankment has to be considered since every structure has different allowable lateral displacement.
數種의 글라스 아이오너머 修復材의 弗素 遊離量과 修復物 邊緣 琺瑯質에 吸收된 弗素 含量에 관한 硏究
김종수,손일수,김용기 단국대학교 치의학연구소 1992 논문집 Vol.4 No.-
In this study, various kinds of glass ionomer filling materials were evaluated for fluoride release and uptake by adjacent enamel. Fuji Ⅱ, Ketac-Fil, Ketac-Silver were used for this study and Silux plus was selected for control group. Measurements of fluoride concentration released in solution from discs made of selected materials were performed daily for the first 7 days and on the 14th, 21st day after the experiment. In order to evaluate the amount of fluoride uptake by enamel adjacent to restorations, pre-op and post-op enamel biopsy were done on every sample teeth. Ketac-Fil showed the highest amount of fluoride release among tested materials through whole experimental periods. Statisically significant differences between pre-op and post-op enamel fluoride concentration could be found in Ketac-Fil from the first week and in Fuji Ⅱ from the 2nd week after fillings.
뇌졸중 후 치매환자에서 도네피질(아리셉트^(?))이 인지기능 및 일상생활 수행능력, 삶의 질에 미치는 효과
이상열,장혁,송재은,조성옥,류정미,이미경,조진호,신용일 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.1
Background: This study evaluated the efficacy of administering Donepezil(Aricept^(?)) for improving cognitive function, activities of daily living, and quality of life in patients with post-stroke dementia. Methods: Patients(n=99; mean age, 69.89 years; 48.5% men) with post-stroke dementia, according to criteria of the DSM-IV and MRI, were treated with donepezil 5mg/day or 10mg/day during 24 weeks. They were examined using Mini-mental Status Examination(MMSE), Chinical Dementia Rating(CDR), Barthel Activities of daily living(B-ADL), Instrumental Activities of daily living(I-ADL), Short Form 36 Health Survey-Korean(SF-36-K), and Geriatric Depression Scale(GDS) at before treatment and 24 weeks after treatment. Results: The 97 patients completed the trial. At 24 weeks, they showed significant improvement in MMSE(p<0.001), CDR(p<0.001), B-ADL(p=0.002), I-ADL(p<0.001), and SF-36-K(p=0.003) except GDS(p=0.288). Donepezil was well tolerated. There was no withdrawal due to adverse events. Conclusion: This results demonstrate that donepezil was beneficial in improving the cognitive function, activities of daily living, and quality of life in patients with post-stroke dementia and was well toleraetd.