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두경부암 환자의 방사선 치료시 자체 제작한 고정용구 (Shoulder Retractor)에 대한 유용성 평가
김태준,진선식,김동현,김동욱,정원규,김경태,Kim, Tae Jun,Jin, Sun Sik,Kim, Dong Hyun,Kim, Dong Wook,Chung, Weon Kuu,Kim, Kyoung Tae 대한방사선치료학회 2014 대한방사선치료학회지 Vol.26 No.1
목 적 : 본 연구에서는 두경부 암 환자의 방사선 치료 시 Neck node lower region까지 Target이 위치한 환자의 경우 기존의 상품화 된 두 가지 고정용구와 자체개발한 Shoulder Retractor의 유용성을 비교 평가하고자 한다. 대상 및 방법 : 본원에서 치료한 두경부암 환자 6명을 대상으로 사용한 고정용구의 종류에 따라 각각 2명씩 분류하여 좌, 우 Shoulder 위치변화와 Set up의 정확성을 OBI를 이용한 2D/2D 영상정합 위치보정 후 좌표 분석을 통해 비교하여 유용성을 확인해 보았다. 결 과 : 고정용구 종류에 따른 영상정합 위치보정 값(OBI A-P상 좌, 우 Shoulder 위치변화값)에 대한 평균값과 표준편차는 A그룹에서는 RT.Shoulder $1.07mm{\pm}3.99mm$, LT.Shoulder $-4.35mm{\pm}2.09mm$이고, B그룹에서는 RT.Shoulder $-0.37{\pm}5.91mm$, LT.Shoulder $1.26{\pm}5.28mm$, C그룹에서는 RT.Shoulder $-0.63{\pm}2.44mm$, LT.Shoulder $0.25mm{\pm}1.61mm$으로 나타났다. SET UP의 영상유도좌표 분석에서는 평균 및 표준편차 값이 A그룹에서 Vrt $-2.06{\pm}2.68mm$, Lat $-1.11{\pm}8.15mm$, Lng $0.34{\pm}3.78mm$, Rot $0.51{\pm}0.77^{\circ}$이고, B그룹에서 Vrt은 $-1.18{\pm}1.82mm$, Lat $-0.94{\pm}2.13mm$, Lng $-0.67{\pm}1.98mm$, Rot $0.91{\pm}1.04^{\circ}$이고, C그룹에서 Vrt은 $0.12{\pm}2.18mm$, Lat에서 $-0.79{\pm}1.62mm$, Lng에서 $-0.79{\pm}2.64mm$, Rot $0{\pm}0.49^{\circ}$으로 나타났다. 결 론 : 자체개발한 고정용구는 좌,우 Shoulder의 위치변화에 대한 재현성을 유지시킴에 있어 유용함을 알수있었고, 환자 변위요소(환자가 잡은 줄을 놓치는 현상과 발 끝의 위치와 모양에 따라 잡은줄이 한쪽으로 치우치는 현상)와 환자의 체중 변화로 인한 환자 자세의 고정문제를 줄임으로써 Set up의 오차를 줄이고 환자의 재현성을 유지시키는데 도움이 될 것으로 사료된다. Purpose : We compared the set-up accuracy and right-left Shoulder position variation of the manufactured device and other commercial shoulder-retractors in the head and neck radiation treatment. Materials and Methods : Six patients consist of three groups which were used three different Shoulder retractors. We measured position corrections of left and right Shoulder and the couch after the image guidance by using on board imager (OBI) for six head and neck patients who has the extended target to the neck node lower region. Results : The position variation correction of left (right) Shoulder after image guidance were $1.07{\pm}3.99mm$ ($-4.35{\pm}2.09mm$), $-0.37{\pm}5.91mm$ ($1.26{\pm}5.28mm$), $-0.63{\pm}2.44mm$ ($0.25{\pm}1.61mm$) for group A, B and C. The vertical, lateral, longitudinal position and angular corrections of the couch after image guidance were $-2.06{\pm}2.68$, $-1.11{\pm}8.15$, $0.34{\pm}3.78mm$, and $0.51{\pm}0.77$ degree for group A, $-1.18{\pm}1.82$, $-0.94{\pm}2.13$, $-0.67{\pm}1.98mm$, and $0.91{\pm}1.04$ degree for group B and $0.12{\pm}2.18$, $-0.79{\pm}2.64$, $0.79{\pm}2.64$, and $0.00{\pm}0.49$ degree for group C. Conclusion : In this preliminary study, we found the positioning accuracy of the manufactured Shoulder retractor is comparable to other commercial Shoulder retractors. We expect that the reproducibility and accuracy of the patient set-up could be improved by using the home made Shoulder retractor in the head and neck radiation treatment.
김태준,고용,김영수,오성훈,김광명,오석전,Kim, Tae Joon,Ko, Yong,Kim, Young Soo,Oh, Seong Hoon,Kim, Kwang Myung,Kim, Nam Kyu,Oh, Suck Jun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5
Objective : Surgery for the microvascular decompression is mostly concerned with injury to the cranial nerves or brain stem by cerebellar retraction. Intraopeartive brain stem auditory evoked potentials(BAEPs) has been continuously monitored on surgery to evaluate the extent of injury, recovery of the nerves and prognosis. Methods : Of the 161 cases of CP angle surgery from Feb. 1996 to Apr. 1998, 103 cases were monitored during operation. Thirty five patients who had undergone similar surgery were selected and evaluated ; 23 patients were monitored and 12 were not during surgery. If monitor showed more than 0.5 mSec delay of latency, surgeon was given a warning not to retract brain any more. If more than 1mSec delay, surgeon was informed to stop surgery and wait for the returning of evoked potentials. The level of amplitudes and delay of latencies during the initial stage of operation, opening the dura, insertion of teflon patches, and closing the dura and recovery were then compared. Resuls : Twenty patients were male and 15 were female. Their average age was 50.26 years. Mean amplitude during the initial stage of operation was $0.60{\pm}0.25mV$, at opening the dura $0.56{\pm}0.26$, after teflon patches insertion $0.49{\pm}0.20$, and after closure of dura $0.47{\pm}0.28mV$. Mean latency during the early stage of operation was $6.08{\pm}0.67mSec$, at opening of dura $6.38{\pm}0.55$, insertion of teflon $6.97{\pm}0.59$, and closing the dura $6.17{\pm}0.54$. There was statistical significance in the difference of amplitudes between each procedures, and in the difference of latencies. For the complete recovery of amplitude and latency, it usually took average 5.65 minutes(0-20 min). In monitored group, only one patient required more than 20 minutes to recover and suffered from hearing disturbance after surgery. Others were recovered within 10 minutes without complications. However, 4 out of 12 patients who were not monitored showed hearing disturbance, and 1 patient had temporary facial palsy and dizziness(p=0.000). Conclusion : The results indicate that continuous intraoperative monitoring of BAEPs during CP angle surgery is seen mandatory procedure to prevent operative complications.
요통과 하지방사통에 대한 경막외 스테로이드 주입후 발생한 치명적 합병증 - 증례보고 -
김태준,김충현,정진환,백광흠,김재민,오석전,Kim, Tae Joon,Kim, Choong Hyun,Cheong, Jin Hwan,Bak, Koang Hum,Kim, Jae Min,Oh, Suck Jun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3
Epidural steroid injection(ESI) has been a commonly applied conservative therapy for the management of chronic low back pain and sciatica. However, there are many reports concerning various local, systemic and neurological complications related to ESI. We report two cases with fatal complications after ESI for low back pain and sciatica. In both patients, ventriculitis and meningitis were causative factors to be fatal. Aseptic procedures and careful post-procedure assessment are essential to avoid serious complications following ESI.
김태준,곽병문,이유정,김희택,kim, Tae-Jun,Kwak, Byeong-mun,Lee, You-Jung,Kim, Hee-Taek 대한한방안이비인후피부과학회 2021 한방안이비인후피부과학회지 Vol.34 No.3
Objectives : The purpose of this study is to report the effectiveness of Korean medical treatments on chronic glossitis using Yanggyeok-sangagam based on tutakbeop(透托法), and Ikgibohyeol-tanggagam based on botakbeop(補托法) and bobeop(補法). Methods : We treated a 83-year-old female patient who had glossitis by Korean medicine and acupuncture treatment. These treatments were performed from 2020.8.4. to 2021.3.4. We have confirmed the improvement of white plaque like a pseudomembranous pattern lesion and pain. We recorded images that include change of symptoms. Results : After the treatments were done, the scores of numeric rating scale(NRS), oral assessment guide(OAG) and oral health impact profile-14(OHIP-14) were decreased. The NRS score was decreased from 7 to 1. The OAG score was decreased from 20 to 9. The OHIP-14 score was decreased from 34 to 5. Conclusions : According to the result, Korean medical treatments such as Korean medicine and acupuncture treatment, followed by the cure rules- tutakbeop(透托法), botakbeop(補托法) and bobeop(補法) can be effective for the treatment of chronic glossitis.
김태준 ( Tae-jun Kim ),이재우 ( Jae-woo Yi ) 경희대학교 경희의료원 2019 慶熙醫學 Vol.34 No.1
Gitelman syndrome is a rare autosomal recessive salt-losing renal tubulopathy characterised by hypomagnesemia, hypocalciuria and secondary aldosteronism, which results in hypokalemia and metabolic alkalosis. Acute exacerbation of the hypokalemia and the metabolic alkalosis may interfere with surgery and general anesthesia. Anesthesiologists should be aware of pathogenesis and clinical sypmtoms of Gitelman syndrome to prevent possible complications during perioperative period. It is important to keep an eye on the electrolytes and pH during and after surgery.