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.

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.

COMS 기준 전압 발생기의 설계에 관한 연구

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.

후방 도달 척추 절제술을 이용한 강직성 요천추 변형의 치료

석세일,정의룡,이정희,김진혁,김성수,이지호,최원기,박용원 대한척추외과학회 2004 대한척추외과학회지 Vol.11 No.2

외상 후 뇌 지방색전증 1예

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.

연약지반 성토사면의 안정해석에 관한 연구

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.

Peritoneal Dialysis 1 : Low GDP Dialysate Protects Peritoneum from EMT by Amelioration of Decreased Expression of Anti-fibrotic Factors in Cultured Human Peritoneal Mesothelial Cells

( Jung Hye Kim ),( Kyung Sook Shin ),( Jung Hwa Ryu ),( Mi Na Yu ),( Dong Ryeol Ryu ),( Seung Jung Kim ),( Kyu Bok Choi ),( Kyun II Yoon ),( Yong II Kim ),( Sun Hee Park ),( Yong Lim Kim ),( Duk Hee K 대한신장학회 2006 춘계학술대회 초록집 Vol.25 No.1

Bone Marrow Mononuclear Cells Have Neurovascular Tropism and Improve Diabetic Neuropathy

Kim, Hyongbum,Park, Jong-seon,Choi, Yong Jin,Kim, Mee-Ohk,Huh, Yang Hoon,Kim, Sung-Whan,Han, Ji Woong,Lee, JiYoon,Kim, Sinae,Houge, Mackenzie A.,Ii, Masaaki,Yoon, Young-sup Wiley (John WileySons) 2009 Stem Cells Vol.27 No.7

<P>Bone marrow-derived mononuclear cells (BMNCs) have been shown to effectively treat ischemic cardiovascular diseases. Because diabetic neuropathy (DN) is causally associated with impaired angiogenesis and deficiency of angiogenic and neurotrophic factors in the nerves, we investigated whether DN can be ameliorated by local injection of BMNCs. Severe peripheral neuropathy, characterized by a significant decrease in the motor and sensory nerve conduction velocities (NCVs), developed 12 weeks after the induction of diabetes with streptozotocin in rats. The injection of BMNCs restored motor and sensory NCVs to normal levels and significantly improved vascular density and blood flow in diabetic nerves over 4 weeks. Fluorescent microscopic observation revealed that DiI-labeled BMNCs preferentially engrafted in sciatic nerves. Whole-mount fluorescent imaging and confocal microscopic evaluation demonstrated that many of the BMNCs localized following the course of the vasa nervorum in close proximity to blood vessels without incorporation into vasa nervorum as endothelial cells at a detectable level. Real-time reverse transcription-polymerase chain reaction analysis showed that the levels of angiogenic and neurotrophic factors were significantly increased in the nerves by BMNC injection. Local transplantation of BMNCs improved experimental DN by augmenting angiogenesis and increasing angiogenic and neurotrophic factors in peripheral nerves. These findings suggest that BMNC transplantation may represent a novel therapeutic option for treating DN.</P>

CO2-O2-Halothane 마취에 관한 고찰

김성덕,김광우,김용락,곽일용 대한마취과학회 1975 Korean Journal of Anesthesiology Vol.8 No.2

There are numerous experimental reports on the effects of the inhalation of CO2 in animals but little known in the human being except the accidental inhalations. The authors experienced recently accidental inhalations of CO2 instead of nitrous oxide for the purpose of giving nitrous oxide-oxygen-halothane anesthesia in two cases by changing color of gas cylinder. Although outcomes of above two cases are uneventful, we noted cardiac arrhythmias, oozing in the operative field, cyanotic skin, hypertension, hot canister and .easy restoration of spontaneous respiration. We estimated experimentally FiCO2 by measuring FiO2 with Beckman D-2 paramagnetic oxygen analyzer and reviewed literatures in discussion.

기관절개에 후발한 기관협착절제 및 문합술을 위한 전신마취의 임상적 고찰

김재문,김성덕,곽일용,김용락 대한마취과학회 1974 Korean Journal of Anesthesiology Vol.7 No.1

A 34 year old male patient underwent emergency operation of tracheal resection and primary end-to-end anastomosis to correct of tracheal stenosis following tracheostomy. On admission, a No. 3 Magill plastic Portex tracheostomy tube had been placed in the previous tracheostomy opening. Stenotic narrowing was noted 4 cm above carina. Despite of severe narrowing of the lesion, anesthetic course was uneventful with nitrous oxide, oxygen and halothane by controlled respiration and serial blood gas analyses. Postoperative courses were also favorable with adequate respiratory cares. It is mandatory to perform serial blood gas analyses for the management of corrective operation on tracheal stenosis.