비복신경이식을 이용한 긴 거리의 말초신경 결손부 수복

이종호,이세영,김명진,이은진,안강민,김성민,최원재,명훈,황순정,서병무,최진영,정필훈 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.2

The surgery of oral and maxillofacial area poses the risk of cranial nerve damage such as trigeminal nerve or facial nerve. Inferior alveolar nerve is prone to damage in the third molar extraction, implant installation, orthognathic surgery, open reduction and rigid fixation, and tumor ablation surgery. On the other hands,facial nerve is likely to be damaged or sacrificed with trauma or parotidectomy. In case of inferior alveolar nerve injury, the incidence is reported to be about 1.3%. The nerve function will almost recover in minimal damage, but it won't recover at last in total damage of a part of nerve unit. In latter cases, nerve regeneration in intended by allograft as nerve substitute or various route of merve condit. But the recovery with autograft is believed to be most relialbe mrthod in the rapair of long-span(longer than 15㎜)nerve defect. We have performed autologous sural nerve graft in the repair of nerve defect, which is caused by resection of benign or malignant tumor. Hereby we report the method of nerve harvesting, recovery of defected peripheral nerve and the complications of donor site with the discussion of sural nerve anatomy.

K 대학병원 서어비스에 대한 소비자 만족도

이태섭,박종원,이무식,윤능기,이충원,서석권 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.3

Authors administered a questionnaire to 300 clients visited to the K University Hospital during August in 1992 to investigate the degree and related factors of consumer's satisfaction with the hospital services. Clients consisted of 82 in-patients and 158 out-patients, 52.4 percent of them was male. Four dimensions of satisfaction were assessed which were medical management, administration, environment and attitude. In-patients reported as dissatisfied with the waiting time during receipt, investigative medical procedures and pharmacy (64.7%), lack of conveniency facilities for patients and their guardians(48.8%) and provision of conveniency facilities in the ward(42.4%), unsanitary state of out- and in-hospital(41.5%). Out-patients reported dissatisfaction with the course of medical management and the time needed(70.3%), the waiting time during receipt, investigative medical procedures and pharmacy(68.3%), lack of conveniency facilities for patients and guardians(42.4%). But both in-patients and out-patients were satisfied with medical equipments, doctor's diagnosis reliability and medical effects, technician's attitude more than 50%. Canonical correlation analysis was done to find related sociodemographic factors to the four dimensions of satisfaction. Of the four canonical functions, the first was only statistically significant in in-patients. Its eigen value was 0.56 and its canonical correlation coefficient was 0.60. Satisfaction with environment and medical management was selected as important concept in dependent variables. Standardized canonical function of environment and medical management were 0.76 and 0.35 respectively. It was related with woman with high educational attainment and increasing number of hospital visits. In out-patients, the first, second and third function were statistically significant and their eigen values were 0.18, 0.4, 0.08 respectively which were small compared to those of in-patients. Their canonical correlation coefficient were 0.40, 0.35, 0.28 respectively. Low degree of environment but high degree of medical management satisfaction was noted in the first function which was related with old age, woman and professional occupation. Low degree of satisfaction with administration(second function) was related with city resident, non-professional occupation and young age. High degree of medical management but low degree of administration satisfaction(third function) was related with surgical visitor, man and non-professional occupation. The direction of hospital managerial strategies could be planned and general characteristics of dissatisfactory clients might be suggested with these results.

종합검진센터 내원자에서 관상동맥질환 위험요인들의 분포

이충원,이종영,박종원,윤능기,김영조,이현우,이무식,서석권 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.3

1991년3월부터 8월사이에 대구시에 소재한 1개의 대학병원의 종합검진센타에 내원해서 종합검진을 받은 남자 422명(69.9%)과 여자 182명(30.1%)을 대상으로 하여 심헐관계질환의 위험요인들의 전체적인 분포를 보았다. 평균 연령은 남자가 43.3(표준편차, 10.3), 여자가 44.4(표준편차, 10.8)였다. 남자에서 연령에 따라 0.05 수준에서 통계적인 유의성을 보인 위험인자는 혈청 총콜레스테롤(TC). 트리글리세라이드(TC), 고밀도 지단백콜레스테롤(HDL), 저밀도 지단백콜레스테롤(LDL), 수축기혈압, 비체중, A형행동양상이었으며 생활습관으로서는 음주, 흡연, 규칙적인 운동, 우유와 커피섭취, 수면 등이었다. 여자에서는 TC, TG, LDL, 수축기와 확장기혈압, 비체중 그리고 커피섭취와 수면 등이었다. 남자에서 총콜레스테롤의 평균은 181.7mg/dl(표준편차, 32.2), 여자는 182.5mg/이(표준편차, 42.2)였다. 대부분의 위험인자들은 구미의 수준에 미치지 못했으나 남자에서 흡연율이 전체적으로 61.8%로 높으 수준이었으며 특히, 20~29세가 72.9%, 30~39세가 75.2%로서 다른 연령군에 비해 상대적으로 높았다. 여자에서는 전체적으로 6.0%에 지나지 않았다. 확장기혈압 90mmHg 이상을 고혈압자로 정의했을 때의 유병률이 여자 전체대상자에서 24.7%로 높았으며 50-59세는 표본수가 적어서 문제가 되었으나 53.1%였다. 어떤 인구집단내에서 총콜레스테롤의 평균이 200mg/dl 미만이면 고혈압과 흡연의 인구집단의 수준에 관계없이 관상동맥질환(coronary heart disease)의 발생은 드문 것으로 보고가 되고 있으므로 당분간 관상동맥질환 발생률의 급속한 절대적인 증가는 힘드리라 사료된다. 그러나 이러한 결과는 본 연구의 대상자들이 대표성을 지니지 못하며 건강검진센터에 자발적으로 내원한 사람들이므로 해석에 주의를 요한다. Authors examined the distributions of the risk factors for the coronary heart disease in the 422 male (69.9%) and 182 female (30.1%) visitors to the health examination center of a university hospital located in Taegu March to August 1991. Mean age of males was 43.3(standard deviation, SD 10.3) and that of females was 44.4(SD 10.8). Total cholesterol(TC), triglyceride (TG), high-density lipoprotein and low-density lipoprotein cholesterol(LDL), systolic blood pressure, Quetelet index, and Type A Behavior Pattern, and some of life habit variables(alcohol intake, smoking, regular exercise, milk and coffee intake and sleeping) were statistically significant in age groups of the males(P<0.05). In the females, TC, TG and LDL, systolic and diastolic pressure, Quetelet index, coffee intake and sleeping were statistically significant in age groups (P<0.05). Mean of total cholesterol was 181.7㎎/dl(SD,32.2) in males and that of females was 182.5㎎/dl(SD,42.2). Most of the risk factors levels were lower than the Euro-Americans', while smokers were high with 61.8%, especially 72.9% in 20-29 age group and 75.2% in 30-39 age group in males. In females, smokers were just 6.0%. Hypertensives defined by more than 90mmHg diastolic pressure were 24.7% in females, particularly 53.1% in 50-59 age group, but size of the strata was rather small(N=49). In the light of the report that coronary heart disease is uncommon irrespective of population levels of smoking and hypertension, where average total blood cholesterol level in a population is low(<200mg/dl), it is not likely that the absolute increase of the number of the coronary heart disease will increase markedly in the near future. But cautions should be exercised in interpreting the results of this study due to the lack of representativeness and volunteerism. .

신부전이 동반된 당뇨병 환자에서 발생된 침습성 모균증 : 수술과 Liposomal amphotericin B 및 GM-CSF 병합 요법에 의한 성공적인 치험 1예

이원영,오기원,임국희,장재혁,이동건,최정현,강무일,신완식,차봉연,이광우,손호영,강성구 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.4

저자들은 신부전이 동반된 당뇨병 환자에서 발생된 부비동형 모균증에 대하여 수술과 함께 liposomal amphotericin B 및 GM-CSF의 복합치료를 하여 성공적으로 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Mucormycosis (zygomycosis) primarily affects diabetic or immunocompromised patients and typically progresses rapidly, necessitating surgical excision and antifungal therapy with amphotericin B. Large doses of amphotericin B are needed for cure, but it has the risk of causing significant renal toxicity. The recent development of liposomal amphotericin B allows antifungal therapy to be administered with potentially improved efficacy and reduced nephrotoxicity. We have experienced a case of paranasal mucormycosis successfully treated with surgery, liposomal amphotericin B and GM-CSF. A 59-year-old male suffering from diabetes mellitus for 6 years was admitted with pain at left maxillary area. He was diagnosed as mucormycosis after cytologic exam on the necrotic nasal mucosa, which showed typical hyphae. He have had diabetic nephropathy with macroproteinuria and had rapidly rising serum creatinine levels with the amphotericin B treatment: creatinine levels reverted to basal level with the use of liposomal amphotericin B. Despite surgical excision and continued antifungal therapy, his infection was not effectively controlled. Therefore, GM-CSF was administered additionally to improve phagocytic activity of leukocytes. He was finally cured after receiving a combination of aggressive surgery, liposomal amphotericin B and GM-CSF. To our knowledge, this is the first detailed clinical description of the treatment of mucormycosis with liposomal amphotericin B in Korea.

조혈모세포이식술이 골수기질세포의 기원 및 조골세포로의 증식 및 분화에 미치는 효과

강무일,조성원,오은숙,백기현,이원영,오기원,김혜수,한제호,윤건호,차봉연,이광우,손호영,강성구,김춘추 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.4·5

절수에 의한 Mongolian Gerbil 장기중량변화에 관한 분석연구

김무강,이기훈,이강이,송치원,이경열,권효정,박미선,정승혁,이행연,김명철 충남대학교 수의과대학 동물의과학연구소 2000 動物醫科學硏究誌 Vol.8 No.-

In this study, authors measured the each organ weight of the long term water deprived Mongolian gerbil, after then we calculated the mean, standard deviation, variance coefficient of the real measured organ weight and induced the organ weight change quantity, rate of quantity, deviation between measured and theological organ weight, deviation rate, sum of deviation rate, organ weight change rate, rate of organ weight by the mathematical formula. The results obtained as follow 1. The weight of the brains, lung, and testis were abruptly decreased after water deprived until the 5th day, after then slowly decreased until the 20th day. 2. The weight of the heart was decreased gradually from the first day until the 20th day. 3. The weight of the liver was abruptly decreased until the 10th day, after then the more slowly decreased until the 20th day. 4. The weight of the thymus, spleen, kidney, and pancreas were abruptly decreased until the 15th day, after then increased slowly until 20th day but the weight of the kidney was abruptly increased from the 10th day. 5. The organ weight change rate and the rate of the each day organ weight were very diversified.

사후분해 시체에 대한 법의학적 접근

최영식,이상용,김유훈,조갑래,이봉우,양경무,정낙은,서중석,이한영,이원태,강현욱 大韓法醫學會 2000 대한법의학회지 Vol.24 No.2

Disposal of a homicide victim by dismemberment is rare, but individual cases are on record in most major medicolegal departments. Recognition of postmortem mutilation may be of importance in the interpretation of certain murders committed by sexual perverts and other mentally deranged individuals and sometimes performed for the sole reason of easier disposal of the body. Postmortem dismemberment is usually readily recognizable as such; The edges of the injuries are dry and lack evidence of bleeding. The joints may be disarticulated without fracture, or the use of an axe or saw may be evident from examination of bones. Parallel horizontal or oblique furrows in the bone surface are caused by skipping of the saw prior to establishing depth. Such patterns on the bone may assist in identifying the particular saw involved. So we report 25 dismembered corpses that autopsied in National Institute of Scientific Investigation. This paper can help in attempting to establish not only the first criminal investigation steps but also the medicolegal approach methods in unidentified and dismembered deaths.

저장 온도 및 상대습도가 비타민 정제 중 지용성 비타민 함량의 변화에 미치는 영향

김동섭,이재황,김세곤,이동언,박석준,이진희,이강표,최성원,백무열 경희대학교식량자원개발연구소 2007 硏究論文集 Vol.26 No.1

영구형 항서맥 심박조율기 환자의 장기추적관찰

최현석,이무용,최영진,최성준,김효수,손대원,오병희,이명묵,박영배,최윤식,이영우,이명용 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.5

당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.