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      • 경추에 발생한 척삭종의 세침흡인 세포학적 소견 - 1예 보고 -

        양경무,조미연,정순희,봉정표,Yang, Kyung-Moo,Cho, Mee-Yon,Jung, Soon-Hee,Bong, Jeong-Pyo 대한세포병리학회 1997 대한세포병리학회지 Vol.8 No.1

        A case of cervical chordoma diagnosed by fine needle aspiration is discussed. A 41year-old male was admitted due to dyspnea on neck flexion. Radiologic image revealed a retrotracheal superior mediastinal solid mass. Aspiration cytology showed many clusters of oval or large polygonal cells having abundant eosinophilic or bubbly cytoplasm in an amorphous blue-gray mucoid background. The nuclei were round and showed size variation, coarse granular chromatin, and indistinct nucleoli. Some cells contained brown granular pigments in the cytoplasm. Mitoses were rarely found. The cytoplasm was strongly positive for PAS stain. Immunohistochemical stains using cell block revealed positive reaction for cytokerain, EMA, vimentin, and S-100 protein. The confirmative diagnosis was made by following excisional biopsy. Electron microscopic study revealed large pools of intracytoplasmic glycogen and microfilaments. This is the first case of cervical chordoma diagnosed by aspiration cytology to our knowledge in Korean literature.

      • 유리공장피판을 이용한 식도재건술

        양경무,배형운,Yang, Kyung-Moo,Bae, Hyung-Woon 대한미세수술학회 1998 Archives of reconstructive microsurgery Vol.7 No.1

        Despite of technical advances in surgery & other therapeutic modalities five-year survival rates in patients with carcinoma of hypopharynx have remained low. Many techniques have been used to create a structure capable of allowing the passage of food and fluids in an attempt to maintain the anatomy and physiology of the upper digestive system. The development of microsurgical techniques and the concept of mucocutaneous unit has brought about important changes in the reconstruction of cervical esophagus following tumor resection. The one-stage procedure using microvascular anastomosis of free jejunal graft provides physiologic reconstruction of cervical esophagus and has a low morbidity rate as well as a short recuperation time. With free jejunal graft, there is marked improvement in the quality of life and numerous advantages over the previous methods of reconstruction. Reconstruction of esophageal defect after resection of carcinomas of the hypopharynx, and cervical esophagus has traditionally been carried out with deltopectoral, or musculocutaneous skin-lined flaps. A second approach is to reconstruct the defect with the colon or stomach. A more ideal mettled is to repair these defects with mucosa-lined flaps. The authors experienced 35 cases of reconstruction of cervical esophagus after resection of carcinoma of the hypopharynx with free jejunal autograft and one case of secondary repair with radial forearm free flap after failure of initial free Jejunal autograft. Postoperative results were satisfactory in most patients and two patients expired in 8 days postoperatively because of carotid blow out by chronic inflammation.

      • 외측대퇴 유리피판을 이용한 두경부 결손의 재건

        이내호,양경무,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 1998 Archives of reconstructive microsurgery Vol.7 No.2

        저자들은 1997년 1월부터 1998년 7월까지 두경부 악성종양 및 반안면왜소증과 같은 선천성 안면기형을 주소로 본원에 내원하였던 환자 9명을 대상으로 하여 9례의 외측대퇴 유리피판술을 시행하여 다음과 같은 결과를 얻을 수 있었다. 첫째, 두경부 재건에 있어서 외측대퇴 유리피판은 다른 유리피판술에 비해 여러 장점을 가지고 있었다. 특히, 공여부 추형이 노출되지 않는 부위이며 동시에 두팀이 수술에 참여할 수 있어서 수술시간이 단축될 수 있었다. 둘째, 술후 방사선치료를 시행하면 피판의 모발은 사라지지만 모공의 과각화증 및 색조 침착이 증가하므로, 외측대퇴부에 모발이 많은 환자는 술후 방사선치료의 여부와 관계없이 미용적인 금기사항에 해당한다. 셋째, 악성종양 절제후에 발생하는 결손의 재건시 피판의 두께가 문제시 되지 않았으며, 피판의 두께는 피판을 도안할 때의 위치, 성(sex), 피하지방층의 제거정도, 근육의 포함 정도, 술 후 피판의 위축정도에 따라 조절 가능하였다. 넷째, 모든 증례에서 정맥이식없이 혈관문합이 가능하였으므로 두경부 재건시 혈관경의 길이는 충분한 것으로 사료된다. 다섯째, 가능한 피판을 장축으로 길게 도안하여 두 번째 또는 네 번째 관통동맥을 포함시켜 수술 후 발생할지도 모르는 혈류부전에 대비하는 것도 피판의 생존률을 높이는 좋은 방법으로 사료된다. Microvascular surgery has been widely used clinically for over 30 years. Although many types of free skin and myocutaneous flap are being used at present, surgeons are still looking for new flaps to suit the specific requirements of different recipient sites, to reduce the deformity at the donor site, to ease the management of the flap and to increase the success rate of those operations. The lateral thigh free flap was designed and reported simultaneously with the medial thigh free flap by Baek in 1983. The flap, based on the third perforator of the profunda femoris artery. is designed on the posterolateral aspect of the distal thigh. Clinically, the vascular variations and the locations of perforators of this system can be determined preoperatively with simple angiograms and Dopper audiometry. The lateral thigh free flap is suitable for reconstruction of defects in an oral floor with tongue and esophageal deficits, scalp defects with dural defects, and large full thickness defects of the lip. The advantages of this flap are safe elevation, a long vascular pedicles with a large lumen, skin that is generally thin, and good pliability. Furthermore, the skin territory is very wide and long. The donor site is hidden and therefore more acceptable to the patient. The disadvantage of this flap is that the anatomy of the pedicle vessels has irregular derivation from the main vessel. We had reconstructed lateral thigh free flap to the nine patients from January, 1997 to July, 1998 and got satisfactory results. In this paper we illustrate the arterial anatomy of the thigh and usefulness of this flap for the reconstruction of the head and neck.

      • A Study on the Post-Receptor Mechanism of Adenosine Receptor on Norepinephrine Release in the Rat Hippocampus

        최봉규,김도경,양경무,Choi, Bong-Kyu,Kim, Do-Kyung,Yang, Kyung-Moo The Korean Society of Pharmacology 1996 대한약리학잡지 Vol.32 No.1

        흰쥐 해마(hippocampus)에서 norepinephrine(NE) 유리에 미치는 $A_1-adenosine$ 수용체의 post-receptor 기전에 관한 지견을 얻고자 하여 $^3H-norepinephrine$으로 평형시킨 해마 절편을 사용하여 adenosine의 $^3H-NE$ 유리에 미치는 여러가지 약물의 영향을 관찰하였다. Adenosine($1{\sim}30{\mu}M$)은 전기자극(3 Hz, 2 ms, 5 Vcm-1, 구형파)에 의한 NE 유리를 용량 의존적으로 감소시켰고, 이 효과는 선택적인 $A_1-adenosine$ 수용체 차단제인 $8-cyclopentyl-1,3-dipropylxanthine(2{\mu}M)$에 의해 차단되었다. G-단백 억제제인 N-ethylmaleimide(NEM, 10과 $30{\mu}M$)는 그 자체로써 전기자극으로 유발시킨 NE 유리를 증가시켰으며, adenosine의 NE 유리 억제효과는 NEM 전처리에 의하여 완전히 소실되었다. Protein kinase C 활성화제인 $4{\beta}-phorbol$ 12,13-dibutyrate(PDB, $1{\mu}M$)는 NE 유리 증가를 일으켰고, 이 효소 억제제인 $4{\beta}-polymyxin$ B(PMB, 0.1 mg)는 NE 유리감소를 일으켰으며, adenosine에 의한 NE 유리 감소효과는 PDB에 의해 억제되었고, PMB 전처리하에서는 감소효과가 출현하지 않았다. $Ca^{2+}$-통로 차단제인 $nifedipine(1{\mu}M$)은 adenosine의 NE 유리 억제효과에 영향을 미치지 못하고, ATP에 의존적인 $K^+-$통로 차단제인 glibenclamide역시 adenosine의 NE 유리 억제효과에 영향을 미치지 못하였다. 그러나 delayed rectifier $K^+-$통로 차단제인 tetraethylammonium(TEA, 3 mM)은 그 자체로 NE 유리를 증가 시켰으며, adenosine의 NE 유리 억제효과를 차단함을 볼 수 있었다. 8-bromo-cAMP(100과 $300{\mu}M$) 그 자체로는 NE 유리에 별다른 영향을 미치지 못하였으나 8-bromo-cAMP 전처리에 의하여 adenosine의 NE 유리 억제효과가 억제됨을 볼 수 있었다. 이상의 실험결과로 흰쥐 해마에서 $A_1-adenosine$ 수용체를 통한 adenosine의 NE 유리 감소는 G-단백에 의존적이며, 이러한 효과에 protein kinase C, TEA에 예민한 $K^+-$통로 및 adenylate cyclase계가 복합적으로 관여하고 nifedipine에 예민한 $Ca^{2+}-$통로와 glibenclamide에 예민한 $K^+-$통로는 관여하지 않는 것으로 사료된다. Since it has been reported that the depolarization-induced norepinephrine (NE) release is inhibited by activation of presynaptic $A_1-adenosine$ heteroreceptor in hippocampus, a large body of experimental data on the post-receptor mechanism of this process has been accumulated. But, the post-receptor mechanism of presynaptic $A_1-adenosine$ receptor on the NE release has not been clearly elucidated yet. Therefore, it was attempted to clarify the post-receptor mechanisms of the $A_1-adenosine$ receptor-mediated control of NE release in this study. Slices from rat hippocampus were equilibrated with $^3H-norepinephrine$ and the release of the labelled products was evoked by electrical stimulation (3 Hz, 5 $Vcm^{-1}$, 2 ms, rectangular pulses), and the influence of various agents on the evoked tritium-outflow was investigated. Adenosine, in concentrations ranging from $1{\sim}30{\mu}M$, decreased the NE release in a dose-dependent manner, without affecting the basal rate of release. The adenosine effects were significantly inhibited by 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, $2{\mu}M$), a selective $A_1-receptor$ antagonist. The responses to N-ethylmaleimide (NEM, 10 & $30{\mu}M$), a SH-alkylating agent of G-protein, were characterized by increments of the evoked NE-release and the basal release, and the adenosine effects were completely abolished by NEM pretreatment. $4{\beta}-Phorbol$ 12,13-dibutyrate (PDB, $1{\mu}M$), a specific protein kinase C (PKC) activator, increased the evoked NE release, whereas polymyxin B sulfate (PMB,0.1 mg), a PKC inhibitor, decreased the release, and the adenosine effects were inhibited by these agents. Nifedipine $(1{\mu}M)$, a $Ca^{2+}-channel$ blocker of dihydropyridine analogue, did not affect the adenosine effect. Tetraethylammonium (TEA, 3 mM) increased the evoked NE release, and inhibited the adenosine effects, but glibenclamide, a ATP dependent $K^+-channel$ blocker, did not. Finally, 8-bromo cyclic AMP (100 & $300{\mu}M$), a membrane-permeable analogue of cAMP, did not alter the NE release, but adenosine effects were inhibited by pretreatment with 8br-cAMP. These results suggest that the decrement of the evoked NE-release by $A_1-adenosine$ receptor is mediated by the C-protein, which is coupled to protein kinase C, adenylate cyclase system and TEA sensitive $K^+-channel$, and that nifedipine-sensitive $Ca^{2+}-channel$ and glibenclamide-sensitive $K^+-channel$ are not involved in this process.

      • 유리 피판을 이용한 인두식도 결손의 재건

        문지현,이내호,양경무,Moon, Ji-Hyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 1999 Archives of reconstructive microsurgery Vol.8 No.2

        저자들은 1990년 12월부터 1999년 2월까지 48례의 경우에서 하인두에 발생한 악성종양을 광범위 절제한 후 유리피판 또는 근피판을 이용하여 재건하였다. 39례에서 유리공장 피판, 5례에서 유리전박 피판을 tubing 형태로 사용했으며, 2례에서는 유리전박 피판을 patch 형태로 사용하였고, 2례에서는 대흉근 근피판을 이용하여 경부식도를 재건하여 다음과 같은 결과를 얻을 수 있었다. 1. 하인두의 악성종양이 고령의 나이에 발생한다는 사실을 감안했을 때 유리전박 피판에 비해 급양공장루를 통해 조기에 영양섭취가 손쉬운 유리공장 피판이 환자의 상태를 정상으로 회복시키는데 장점이 있었다. 2. 술후 가장 흔한 합병증인 누공의 발생은 문합을 제대로 시행했을 경우 우려할 필요 없으며, 따라서 술후에 시행하는 식도조영검사는 누공의 증상이 있는 경우에만 선별적으로 실시해야 할 것이다. 3. 문합부 내경의 협착이 우려될 때는 직경이 큰 비강영양튜부(nasogastric tube)를 조기에 삽입하여 극단적인 협착을 감소시키고, 영양섭취 경로를 확보해야 한다. 4. 문합부 협착을 예방하기 위해 상하부 문합부 모두를 파형으로 도안하여 피판을 문합 봉합해야 하며, 협착이 의심스러울 때는 내시경검사를 시행하여 확진해야 한다. 5. 혈관문합은 유리전박 피판을 시행하는 경우에 있어서 수월하였으며, 유리공장 피판을 시행할 때는 술전에 정맥이식을 고려해야 한다. The laryngopharyngectomy for tumor ablation is the most common indication for pharyngoesophageal reconstruction in our country. Most of these cases are advanced laryngeal cancer that has spread beyond the larynx, pharynx and cervical esophagus. Such patients are obviously unable to breathe, swallow, or speak in the normal manner. The ideal reconstruction would restore normal anatomy, permitting patients to breathe and swallow without aspiration, and would not require a permanent tracheostomy. Reconstruction of the pharyngoesophageal defect traditionally been carried out with tubed local random flap, deltopectoral or musculocutaneous flap. Another approach is the pedicled enteric flap. But microsurgical reconstruction of the pharyngoesophagus, using either the free jejunal or the tubed radial forearm flap, have now become the preferred technique. Among them, we used jejunal free flap in 39 cases, tubed radial forearm free flap in 5 cases, patched radial forearm free flap in 2 cases and pectoralis major myocutaneous island flap in 2 cases from December 1990 to Febrary 1999. In this paper we illustrated that both forearm and jejunal free flap is a usful alternative in reconstruction of hypopharynx and cervical esophagus.

      • 유리 비골 전이술을 이용한 하악골 재건술

        오명록,이내호,양경무,Oh, Myung-Rok,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 1999 Archives of reconstructive microsurgery Vol.8 No.1

        The need for reconstruction of large bone, soft tissue defect of mandible has greater emphasis due to development of industry, traumatic accident and increase of tumor. The mandibular reconstruction had greatly progressed through the first and the second World Wars. The Fibular free flap by using microscope was reported in 1970 and many maxillofacial reconstructive surgeons had used. In 1988, Dr. Hidalgo first reported mandibular reconstruction by using fibular free flap. Mandibular reconstruction by using fibular free flap has several advantages. First, it provides up to 25 cm of bone, enough to reconstruct any length of mandible defect. Second, a skin island, based on a septocutaneous blood supply, is available in a size large enough to simultaneously reconstruct internal and external soft tissue defect. Third, The fibular donor site morbidity is low, fourth, it provides a esthetic effect of mandible line. And finally bone viability is good. The Fibular osteocutaneous free flap was performed after COMMANDO operation due to squamous cell cancer in oral cavity (15 cases). Therefore we report out successful operation of the mandible reconstruction by using fibular osteocutaneous free flap.

      • 완전 절단된 외이의 재접합

        정성모,배충상,이내호,양경무,Chung, Sung-Mo,Bae, Chung-Sang,Lee, Nae-Ho,Yang, Kyung-Moo 대한미세수술학회 2005 Archives of reconstructive microsurgery Vol.14 No.2

        The auricle is easy to be amputated in the face due to its protruding position. When facial parts are amputated, the mechanism of injury usually involves some form of avulsion, which damages these fragile vessels over a distance and renders them unsuitable for anastomosis. Replantation of the ear remains a challenging problem because of the tiny vessels and the paucity of adequate veins for anastomosis. Reattachment as a composite graft of the total or subtotal amputated ear is unreliable. Microsurgical replantation can be performed in a minority of cases because of technical difficulties and long operation time. In this article, the authors report two case of a successful ear replantation of completely amputated auricle. Only one artery and one vein were anastomosed in first case. In the other case one artery was anastomosed without vein. Instead of venous repair, multiple incision was done with leech application therapy. and the outcome was successful. In spite of the technical difficulties and long operation time, microsurgical replantation of amputated ear is better than other reconstructive method or reattachment without microsurgery.

      • KCI등재

        수부의 고압 분사 손상

        김성기,노시균,이내호,양경무,Kim, Seong-Ki,Roh, Si-Gyun,Lee, Nae-Ho,Yang, Kyung-Moo 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

        Purpose: High-pressure injection injury is caused by accidental injection of the high-pressure injection devices in industry. The initial benign appearance of the wound fools patients into delays in an adequate treatment. And it can result in disastrous outcomes such as necrosis and amputation. To avoid the poor prognosis, the injuries require a prompt surgical intervention. The purpose of this article is to recognize the poor outcome of the highpressure injection injury and to introduce an adequate treatment in need. Methods: We have 4 cases of the high-pressure injection injuries in the hand from April, 2005 to March, 2009. Average age is 39 years (30 - 49 years old), 2 cases are the palm of dominant hand, 1 case is the thumb of dominant hand, and 1 case is the palm of non-dominant hand, respectively. We followed up these patients for 20 months on average. In 3 cases, the immediate, aggressive surgical intervention was carried out, but the other one was delayed in early adequate treatment. The wounds were covered by local advancement flap, anterolateral thigh free flap, conservative treatment with antibiotics and dressing. Results: No pathogens after culture were found nor any findings of fracture in imaging study. Conservative treatment, local advancement flap and anterolateral thigh free flap for the open wound resulted in a desirable aesthetic outcome. In a long-term follow up, functional capability of the patient was also satisfactory. Conclusion: Upon initial evaluation, most high-pressure injection injuries present as innocuous wounds with very few symptoms and result in delaying the proper management. And the majority of high-pressure injection injuries will produce significant morbidity to the hand, amputation. And the initial aggressive surgical debridement was needed to prevent the poor outcome. The key to success in treating high-pressure injection injuries of the hand is the prompt aggressive surgical intervention.

      • SCOPUSKCI등재

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