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다한증 환자에서 클립을 이용한 교감신경 교통가지 차단술 사체 연구 및 임상적용
이성호,조성준,정재승,김태식,손호성,선경,김광택,김형묵 대한흉부외과학회 2003 Journal of Chest Surgery (J Chest Surg) Vol.36 No.8
배경: 다한증 환자의 가장 효과적인 치료방법은 흉강경 최소절개를 이용한 교감신경 차단술로 알려져 있다. 하지만 수술 후 발생하는 보상성 다한증과 무한증이 수술의 만족도를 감소시키는 중요한 요인이므로 환자에게 적극적인 수술 적응을 하기가 어렵다. 합병증을 줄이기 위한 방법으로 교감신경의 선택적인 교통가지 차단술을 시행하였으나 시술의 어려움과 혈관 손상으로 인한 출혈의 위험성으로 보편화되지 못하였다. 본원에서는 사체를 이용하여 새로운 수술기법을 연구하고 이를 임상에 적용하여 좋은 결과를 얻었기에 보고한다. 대상 및 방법: 포르말린 처리를 하기 전 사체 3구를 대상으로 실험하였다. 앙와위에서 전흉부를 모두 절제한 후 양측 흉부 교감신경을 노출시켰다. 교감신경의 분지와 교통가지의 위치를 확인하였고 2번째와 3번째 교통가지에 클립을 이용한 차단술을 시행하였다. 교통가지 차단술 후 교감신경절을 포함한 교감신경을 절제하여 교통가지의 차단 정도를 관찰하였다. 임상적용은 25명의 환자에서 시행하였으며 평균 연령은 21세였다. 수술은 전신마취와 양측 폐 환기를 하고 반 좌위 자세에서 시행하였다. 4번째 늑간에 2 mm 흉강경을 삽입하였고 겨드랑이에 5 mm 트로카를 삽입하고 내시경용 클립을 이용하여 2번째와 3번째 교감신경절 교통가지를 차단하였다. 수술 후 전화 설문 조사를 통하여 합병증의 유무, 만족도, 보상성 다한증의 발생 정도를 관찰하였다. 결과: 사체 3구에서 모두 교감신경 교통가지의 차단을 완벽하게 시행할 수 있었다. 임상환자에서 모두 수술로 증세의 호전이 있었으며 기존의 교통가지 절제술에 비하여 수술 시간을 단축할 수 있었고 수술로 인한 합병증은 발생하지 않았다. 수술 후 수부 다한증은 모든 환자에서 호전되었으나 4명의 환자는 수술의 만족도가 감소하였다. 보상성 다한증은 15명의 환자(60%)에서 중증 이상으로 발생하였고 6명의 환자는 없거나 잘 느끼지 못하는 정도로 발생하였다. 미각다한증은 2명의 환자에서 발생하였으나 정도는 심하지 않았다. 결론: 본 연구의 수술방법은 2개의 피부 절개와 하모닉 스칼펠, 클립을 사용하여 쉽게 교감신경의 교통가지를 차단할 수 있었고 교통가지 절제술에 비하여 수술시간 및 출혈의 위험성을 감소시킬 수 있었다. 또한 교감신경 절제술에 비하여 비슷한 정도의 수술 성공률을 보이면서 보상성 다한증의 정도나 발생 빈도를 줄일 수 있어 우수한 수술 방법이라 생각한다.
이성호,이동녕 대한금속재료학회(대한금속학회) 1988 대한금속·재료학회지 Vol.26 No.3
A two dimensional finite difference model has been developed to calculate the temperature distribution and the solidification profile of the continuously cast beam blank. The effect of the Pouring temperature, the casting speed, and the cooling condition has been examined. It has been shown by the calculation that the surface temperature and the solid shell thickness of the cast do not significantly vary with the pouring temperature or the casting speed, and that the effect of the cooling condition, particularly in the mold is critical. Non-uniform cooling resulting from the air gap formation develops the thermal stress in the solid shell and this is the main cause of the surface defects. Consequently, rather soft cooling should be applied to decrease the possibility of the crack formation.
李成浩,崔三鎔 부산대학교 사회과학대학 1985 社會科學論叢 Vol.4 No.2
Recently, the drastic decrease of population in the rural areas has emerged as a serious issue. This trend, stemmed directly from the phenomena of urbanization following the high rise industrialization, can be to some extent blamed on the existing direction of both the economic and regional development policy. Namely, the development scheme, based on the manufacturing-led growth center model Korea has pursued since 1960s, has brought about the relative stagnation in the rural part of the nation, causing naturally the outmigration of rural population into the urban areas. The rural decline ensued from the successive population drain entails various aspects of the negative impacts, such as the wide range of interregional income disparities which may disrupt the national consensus of the nationhood and raise the dual structure in the physical land space. This paper, viewed from the above problem statement, is aimed at analyzing the effect of the case of inducing the factories into the rural areas as a development strategy for the efficient rural settlement of population and also investigating the status of the present rural manufacturing to identify what is required to support such project. The manufacturing employed from 10 factories in Chinju and its vicinity, consisting of 573 people, was sampled for conducting the case study. Questionnaire survey sheets were given to each respondent to obtain the relevant ranges of socio-economic data relating to his or her work-place and its condition; survey items contain such information as family status, dwelling and its tenure, education, income, transport means for journey to work, and conditions of workplace and jobs. Main findings confirmed through the analysis can be summarized as follows. First, as the result of the analysis on the past trend of population movement, it is identified that the phenomena of the increase and decrease of population has a close relation to the regional distribution of industries. Second, it is revealed that the male is aged higher than the female; the married has the higher portion than the non-married. Third, it is shown that most of the manufacturing workers have the low level of monthly income and educational background. Fourth, it is indicated that some variables such as the present address, the birth place, the place of final education, and the dwelling place before taking jobs have intimate relationships with each other; it also appears that in view of no evidence of taking the present job to be a factor of population movement, the setting up of factories in the rural areas can't be a component of population migration. Fifth, it is found that the level of satisfaction of the present job varies on the basis of job training experience and the level of monthly income. Accordingly, in order to encourage rural people to take a job in the present place, it is apparently necessary for creating the job training programs for procurement of the job-related technical license as well as taking some policy measure to improve the existing wage systems. Sixth, it is also found that the rural area has still the potentiality to provide quality of labor forces for its own manufacturing operation, that is an important factor for the rural base factories to be managed in the better direction. Seventh, it is identified that most of the respondents have the commuting distance of 12km or less and the time range of one hour or less, for journey to work; the best desirous mean of transport for factory workers can be the commuting by the walk, the bicycle-riding, and the commuting bus provided by the firm. Eighth, in conclusion it should be pointed out that the success of population settlement in the rural area through the localized manufacturing bases depends upon the common effort by the rural residents, the entrepreneurs, the central government, together with precarious choice of the relevant establishments at the proper scales of the operating units on which procurement of raw materials and search for markets are relied.