거골 경부 골절 및 탈구의 수술적 치료 후 발생한 무혈성 괴사

공일규,서형연,이근배,Kong, Il-Kyu,Seo, Hyoung-Yeon,Lee, Keun-Bae 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.2

Purpose: To evaluate the incidence of avascular necrosis (AVN), prognostic reliability of the Hawkins sign, and clinical outcomes after operative treatment of fracture and dislocations of the talar neck. Materials and Methods: We analysed 16 patients with fracture and dislocations of the talar neck which were treated by open reduction and internal fixation and followed up for more than 2 years. The postoperative radiographs were examined for Hawkins sign and avascular necrosis was confirmed by bone scan. The assessment of clinical results was based on the Hawkins scoring system. Results: AVN was occurred in 2 of 16 cases (12.5%) only in type III. Hawkins sign was found 11 of 16 cases (68.8%), which included 8 cases in type II, 2 cases in type III and 1 case in type IV. The Hawkins sign was not observed in two cases with AVN. In contrast, only 2 of the 5 cases with a negative Hawkins sign developed AVN. According to Hawkins scoring system, 4 patients (25.0%) was in excellent, 7 patients (43.8%) in good, 4 patients (25.0%) in fair and 1 patient (6.3%) in poor. Conclusion: Incidence of AVN after operative treatment of fracture and dislocations of the talar neck was lower than that of previous reports. Hawkins sign had a high prognostic reliability, but absence of Hawkins' sign should not be considered a totally reliable indicator of development of avascular necrosis.

후두기관 분리술로 치료한 만성 흡인 15례

공일규,안수연,김봉직,정은정,이명철,성명훈,김광현,Kong, Il-Gyu,An, Soo-Youn,Kim, Bong-Jik,Jung, Eun-Jung,Lee, Myung-Chul,Kwon, Tack-Kyun,Sung, Myung-Whun,Kim, Kwang-Hyun 대한기관식도과학회 2007 大韓氣管食道科學會誌 Vol.13 No.1

Background and Objectives: Since intractable aspiration in patients with impaired protective function of the larynx often results in multiple episode of aspiration pneumonia, repeated hospitalizations and expensive nursing care. The authors reported the preliminary results of laryngotracheal separation(LTS) in patient with chronic intractable aspiration. The purpose of this study was to report the follow up results of patient outcome with the LTS. Materials and Methods: A retrospective review of 15 patients who underwent LTS between 1996 and 2006 was conducted. Ages ranged from 3 to 72 years. Results: Eight patients had morbid aspiration as a consequence of acquired neurologic injuries and seven patients with congenital neurologic injuries. Two patients had a postoperative fistula, which was well controlled with local wound care. Following LTS, aspiration was effectively controlled in all patients and eight were able to tolerate a regular diet. Conclusion: LTS is a low-risk, successful, definitive procedure which decreases the potential for aspiration, pulmonary complications, duration of hospitalizations and increases quality of life, especially in patent with irreversible upper airway dysfunction and poor speech potential.

현수후두경검사 중 현수력의 지속적인 측정 : 예비보고

공일규,최종민,문성중,차원재,이명철,정은정,성명훈,김광현,권택균 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.11

Background and Objectives:Although suspension laryngoscopy is a very common procedure in the otolaryngoloical field and suspension force (Fs) is suspected to be related with the complications or laryngeal exposure, Fs has not ben objectively Subjects and Method:Sixten patients who had undergone laryngoscopic surgery were evaluated. The value measured with a load cell during the procedure was converted to Fs with calculation. The maximum force (Fsmax) and the mean force (Fsmean) were evaluated. The angle betwen the laryngoscope and the chest holder(angle α), and the angle between the chest holder and the horizontal plane (angle β) were gauged. Results:The mean values of Fsmax and Fsmean were 14.2 and 25.5 kgf, respectively. The mean values of angle α and angle β were 124.0± 4.3°, and 19.0± 2.6°, respectively. Conclusion:The continuous meas-urement of the suspension force was executed successfully and quantitatively with a simple method. (Korean J Otorhinolaryn -gol-Head Neck Surg 207 ;50 :1030-3) 조직의 모세혈관 압력이 문헌에 따라 12~38 mHg 정도로 보고되고 있기 때문에 이론적으로 외부의 압력이 모세혈관압보다 높을 경우, 조직의 울혈이나 허혈 등이 발생할 수 있다.5) 조직에 압력을 주고 손상을 관찰하는 몇몇 실험논문을 살펴보면 보고자에 따라 차이는 있지만 263 mHg에서 6시간 압력을 가하였을 때 심한 근육의 괴사가 발생함을 보고하였다.6) Bouten 등은 2004년 보고에서 15 kPa( 113 mHg)에서 2시간 압력을 가하였을 때 24시간 후 상당한 조직의 손상이 나타났다고 하였다.7) 본 연구에서 기록된 평균현수력이 14.2 kgf(10,451 mHg)이고 힘을 받는 면적을 약 10 cm2으로 가정하면 1,045 mHg의 압력을 받는다고 할 수 있고, 이전 논문들에서의 수치와 비교하였을 때, 노출시간은 짧지만 상당한 압력임을 알 수 있다. 그러나 단순비교에 앞서서 연구에 사용한 조직의 종류와 두께, 주위 구조물과의 관계, 힘의 방향 등을 함께 고려해야 할 것이다. 그러나 증례 중 합병증이 발생한 경우가 없었기 때문에 본 연구에서 측정한 압력 범위는 임상적으로 문제가 발생할 수준에는 미치지 못함을 시사하여, 임상적인 적용을 하기까지는 좀 더 많은 수의 증례 및 합병증이 발생한 예, 나아가 전교련부 노출이 어려웠던 예를 포함하여 분석하는 것이 필요할 것으로 생각된다. 또한 현수력 자체가 합병증을 일으킬 만큼 큰 임계수준에는 도달하지 못한 것으로 판단된다. 후두경과 현수장치에서 측정한 각도 α(holder angle)는 β(support angle) 보다 현수력에 더 큰 영향을 주는 것으로 나타났다. 이는 α가 지렛대의 길이에 직접적으로 영향을 주면서, β보다 더 넓은 범위에 걸친 분포를 가지고 있기 때문으로 해석된다. 그러나 이는 측정값이 아니라 수식을 사용하여 계산된 값을 분석한 결과라는 한계점이 있다. 이는 한 환자의 시술 중 발생하는 α와 β의 변화와 이에 의한 현수력의 변화에 대한 지속적인 측정을 시행하여 보완해야 할 것으로 생각된다. 앞으로 현수력 자체의 객관적 크기가 인체의 조직에 미칠 수 있는 영향 및 실제 수술에 적용하였을 때 변수가 될 수 있는 상황, 즉 후두경의 내경 크기나 종류, 환자가 가지고 있는 임상적 지표들에 관한 심도 있는 전향적 연구가 필요하다 하겠다.

Pathogenesis of Recalcitrant Chronic Rhinosinusitis: The Emerging Role of Innate Immune Cells

공일규,김대우 대한면역학회 2018 Immune Network Vol.18 No.2

Chronic rhinosinusitis (CRS) is a major part of the recalcitrant inflammatory diseases of the upper airway that needs enormous socioeconomic burden. T helper (Th) 2 type immune responses recruiting eosinophils were the most well-known immune players in CRS pathogenesis especially in western countries. By the piling up of a vast amount of researches to elucidate the pathogenic mechanism of CRS recently, heterogeneous inflammatory processes were found to be related to the phenotypes of CRS. Recently more cells other than T cells were in the focus of CRS pathogenesis, such as the epithelial cell, macrophage, innate lymphoid cells, and neutrophils. Here, we reviewed the recent research focusing on the innate immune cells related to CRS pathogenesis.

주 타액선 종양에 대한 10년 간의 경험

공일규(Il gyu Kong),장동엽(Dong Yeop Chang),정은정(Eun-Jung Jung),정영호(Young Ho Jung),하정훈(J. Hun Hah),성명훈(Myung-Whun Sung),김광현(Kwang Hyun Kim) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.2

Background and Objectives :This study reports our clinicopathological experiences of major salivary gland tumors. Materials and Methods :This study included 302 patients with major salivary gland tumors who had got the diagnosis from January 1995 through December 2004. Medical records were reviewed retrospectively. Results :We found 244 benign and 58 malignant major salivary gland tumors. Among 267 parotid tumors, the most common benign parotid tumor was pleomorphic adenoma. Mucoepidermoid carcinoma, adenoid cystic carcinoma, and acinic cell carcinoma were three most common parotid malignancies. Among 33 submandibular gland tumors, 20 cases were benign and 13 were malignant. There were one benign and one malignant su-blingual gland tumors. The duration of symptom of submandibular gland tumors was longer than that of parotid tumors. Most patients presented with asymptomatic mass. Seventy-one percent of salivary gland malignancies underwent postoperative radiation therapy. Five-year disease free survival rate of parotid malignant tumors seemed to be higher than that of submandibular one, although there was no statistical significance. Conclusion :Malignancy rate of each salivary gland followed old axiom that it is inversely related with the size of gland. Submandibular gland tumor tends to be delayed to reach diagnosis. Clinicians must be alert about this finding because submandibular gland tumors are known to have poorer prognosis than parotid tumors.

Wegener 육아종증의 진단과 치료에 대한 임상적 경험

박경태,공일규,한두희,김대우,김시환,이재서,이철희,민양기,김동영 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.12

Because most patients with Wegener’s granulomatosis (WG) visit otolaryngologists complaining of head and neck symptoms, otolaryngologists may play an important role in early diagnosis. In this study, we investigated clinical features, laboratory findings and treatment outcomes of 33 patients with WG, and propose a new algorithm for the diagnosis of WG. Subjects and Method:Thirty-three patients with WG who visited the clinic between January 1980 and December 2007 were included. The medical records of 13 male and 20 female patients were retrospectively reviewed. The mean follow-up duration was 68 months. Results:Most WG patients had ENT symptoms such as nasal obstruction, rhinorrhea, otorrhea, hearing loss, dyspnea and hoarseness. The mean duration from ENT examination to diagnosis was 6.7 months (3 days- 102 months) and tissue biopsy was performed on an average of 2.1 times to confirm the diagnosis. While 16 patients could be diagnosed by the first biopsy, the others were required to repeat the biopsy. ANCA was positive in 17 patients (50%). Twentysix patients (78.7%) had multiple organ involvements such as lung, kidney, joint and skin. Twenty-eight patients received a combination of prednisolone and cyclophosphamide with the remission rate of 87%. Conclusion:Based on this study, we propose a better algorithm for the diagnosis of WG to avoid unnecessary delay in the diagnosis and treatment of WG. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:1109-18)

한국형 후각검사 KVSS 검사에서 후각 인지 검사의 정답률에 관한 분석

안수연,공일규,이철희,김정훈 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.12

Background and Objectives:KVSS (Korean Version of Snifin Sticks) identification test using 16 odorants familiar to Koreans is used for evaluation of olfactory function. We analyzed the correct-answer rate of the odor identification test among KVS test to validate the reliability of these odorants. Subjects and Method:From April 2004 through August 2006, 720 patients under-went an odor identification test and from these, 441 patients who scored more than 9 were included. The score groups were :more than 9, 10, 11 and 12 score group. The age groups were divided into 4 groups:0- 19, 20- 39, 40- 59, 60 and more than 60 year-olds. The diferences in the correct-answer rates of the odorant were investigated according to the score groups, age groups and sex were calculated using SPS software. Results:The odorant 6 (lemon), 7 (licorice), 8 (pine resin), and 11 (apple)rant 7 and 11 were significantly lower than other odorants except odorant 6 and 8 in all score groups, in all age groups and both sex (p≤.001). Conclusion:In the odor identification test, odorants 7 and 11 had low reliabililty for evaluation of the olfactory function, maybe due to unfamiliar odorants to Koreans or test pen failure and they had better be changed into more reliable odorants. For that, we need further investigations about KVSS test before widely used. (Korean J Otorhinolaryngol-Head ;50 :1109-13)

한국형 후각검사 KVSS 검사에서 후각 인지 검사의 정답률에 관한 분석

안수연,공일규,이철희,김정훈 한국레이저가공학회 2007 한국레이저가공학회 학술대회 논문집 Vol. No.

Background and Objectives : KVSS (Korean Version of Sniffin' Sticks) identification test using 16 odorants familiar to Koreans is used for evaluation of olfactory function. We analyzed the correct-answer rate of the odor identification test among KVSS test to validate the reliability of these odorants. Subjects and Method : From April 2004 through August 2006, 720 patients underwent an odor identification test and from these, 441 patients who scored more than 9 were included. The score groups were divided into 4 groups : more than 9, 10, 11 and 12 score group. The age groups were divided into 4 groups : 0-19, 20-39, 40-59, 60 and more than 60 year-olds. The differences in the correct-answer rates of the odorant were investigated according to the score groups, age groups and sex were calculated using SPSS software. Results : The odorant 6 (lemon), 7 (licorice), 8 (pine resin), and 11 (apple) showed low correct-answer rates than other odorants. Especially the correct-answer rates of odorant 7 and 11 were significantly lower than other odorants except odorant 6 and 8 in all score groups, in all age groups and both sex (p≤.000. Conclusion : In the odor identification test, odorants 7 and 11 had low reliabililty for evaluation of the olfactory function, maybe due to unfamiliar odorants to Koreans or test pen failure and they had better be changed into more reliable odorants. For that, we need further investigations about KVSS test before widely used.

동측 간부 골절을 동반한 근위 상완골 골절의 이중 잠김 금속판을 이용한 수술적 치료

문은선,김명선,공일규,최민선,양현기 대한견주관절의학회 2009 대한견주관절학회 학술대회논문집 Vol.2009 No.5

The Surgical Outcome of Reverse Total Shoulder Arthroplasty

문은선,김명선,공일규,최민선,김성규 대한견주관절의학회 2009 대한견주관절학회 학술대회논문집 Vol.2009 No.5