CORBA 기반 Z39.50 서버와 데이터베이스엔진 통합

손충범,강형일,유재수 충북대학교 컴퓨터 정보통신 연구소 2000 컴퓨터정보통신연구 Vol.8 No.1

본 논문에서는 분산 객체 표준 기술이 CORBA를 이용하여 Z39.50 서버와 데이터베이스 엔진들을 통합한다. 이와같이 구현된 Z39.50 서버는 서버처리 부담을 줄일 뿐만 아니라 구현 객체에 대한 위치 투명성을 제공함으로써 다양한 데이터베이스 엔진모듈과의 통합이 가능하게 하여 시스템 확장에 있어 많은 편리함을 제공한다. 또한 데이터베이스 엔진 모듈 부분을 그대로 재사용할 수 있어 자원효율을 높일 수 있는 장점이 있다. In this paper we integrate a Z39.50 server and various database engines using distributed object standard technology called CORBA. The Z39.50 server that supports various database engines based on CORBA not only decreases server process overhead but also provides the location transparency for the implementation object. The Z39.50 server based on CORBA is more flexible in the system extension than existing Z39.50 servers. Since it also can use the database engine module without its modification, it increases resource reusability.

일과성전기억상실증의 국소 뇌혈류 변화 : Statistical Parametric Mapping을 이용한 Tc-99m ECD SPECT분석 Statistical Parametric Mapping analysis of Tc-99m ECD SPECT

이승재,양동원,손영민,김범생,정용안,손형선,주라형 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.1

Background & Objectives:Transient global amnesia (TGA) is a clinical syndrome characterized by sudden memory loss of recent events, transient inability to retain new information, and retrograde amnesia in the absence of other neurological signs and symptoms, resolving within 24 hours. This study investigated alterations in regional cerebral blood flow (rCBF) in patients with TGA by using statistical parametric mapping 99 (SPM99). Methods:5 patients with TGA and 9 age-matched normal control subjects were evaluated. Tc-99m-ethyl cysteinate dimer (ECD) SPECT were performed within 1 to 4 days of the event to measure the regional CBF, and SPM99 were applied to the objective analysis of SPECT data between two groups. Follow-up ECD SPECT was done at 49 to 107 days (mean 76.8) after the previous SPECT to evaluate the long term changes of the regional CBF. Results:The SPM analysis of SPECT images revealed significantly decreased rCBF in the left superior temporal gyrus, the left parietal supramarginal gyrus and the left thalamus (corrected p=0.01) and increased CBF in the contralateral mirror regions in patients with TGA. Follow-up SPECT showed persistent rCBF changes in the same regions. Conclusions:We demonstrate decreased perfusion in the left cerebral hemisphere and increased perfusion in the right cerebral hemisphere in patients with TGA. This reciprocal change of rCBF might suggest that imbalanced neuronal activity between two hemispheres may be important in the pathogenesis of the TGA. Also, the abnormal rCBF changes appeared to last long after the complete recovery of clinical manifestation of TGA.

복합 치아종에 관한 증례보고

최형준,최병재,손흥규,양호정 大韓小兒齒科學會 1995 大韓小兒齒科學會誌 Vol.22 No.2

The odontoma is relatively a common odontogenic tumor. It has come to mean as a growth in which both the epithelial and the mesenchymal cell exhibit complete differentiation, with the result that functional ameloblast and odontoblast form enamel and dentin. The etiology of it is unknown, but it has been suggested that local trauma or infection may lead to the production of such a lesion. Odontma is divided into 2 types. One is compound odontoma that is at least superficial anatomic simiarity to normal teeth, and the other is complex odontoma, that calcified dental tissues are simply an irregular mass bearing no morphologic similarity even to rudimentary teeth. Somtimes this malformation is not easily identified because its lacking of calcification. So, if permanant tooth is delayed to erupt, one should take a careful look the radiographic film to find that whether the cause of it is odontoma or not. In this case report, 3 patients with odontoma who visited Dept. of Pediatric Dentistry in Yonsei Dental College, were treated by means of surgical removal. The obtained results were as follows: 1. The odontoma is usually related to impacted tooth, and it is occurred neighboring to the crown of impacted tooth that have normally developed. So, in the case of missing tooth and delayed eruption, its presence should be investigated. 2. The odontoma can be seen vaguely radiographically, so, it is difficulty to make diagnosis. 3. The treatment of odontoma is a surgical removal. And, if it is completely removed, its occurrence is rare. 4. In the case of impacted tooth being associated with compound odontoma, continuous management is necessary for the eruption of impacted tooth after the surgical extraction of odontoma. 5. It resembles the ameloblastic odontoma radigraphically, and if it is the case, the treatment may vary, so the confirmation through histologic examination after removal of mass is necessary.

한국인 구개파열 아동의 치아발육에 관한 연구

유재형,손동수 大韓小兒齒科學會 1984 大韓小兒齒科學會誌 Vol.11 No.1

The author surveyed the tooth development of 50 cleft affected children (M:34, F:16). The following results were obtained. 1. The difference between the chronologic age and dental age was 0.61 years in the cleft group and 0.15 years in the control group. The delay in tooth development was observed in the cleft group. 2. In the cleft group, there was no difference in the delay of tooth development between the boys and the girls. 3. In the cleft group, there was no difference in the delay of tooth development between the maxilla and the mandible. 4. The delay of tooth development was more severe in the bilateral cleft group than in the unilateral cleft group. 5. In the unilateral cleft, there was no difference in tooth formation between the cleft side and corresponding side.

외상에 의하여 함입된 상악 중절치의 교정적 견인

한윤범,이제호,최형준,손흥규,김성오,송제선,최병재 대한소아치과학회 2009 大韓小兒齒科學會誌 Vol.36 No.2

외상에 의한 치아의 함입은 치아가 치조골 방향으로 변위되어 있는 상태이다. 함입성 탈구는 다른 유형의 탈구성 손상에 비하여 드물게 발생하고, 낙상에 의한 경우가 많으며, 소녀보다는 소년에서 호발하는 것으로 보고되었다. 치아가 함입되었을 때, 치수괴사나 유착, 치근흡수, 근관폐쇄, 변연골 상실 등과 같은 합병증이 발생할 수 있으며, 치아 경조직과 치아 지지조직 등의 손상이 동반되는 경우가 흔하므로, 예후를 예측하고 정확한 진단 및 치료계획을 수립하는데 어려움이 있다. 함입된 치아의 치료는 자발적으로 재맹출하기를 기다리거나, 교정적 견인 또는 외과적으로 재위치 시키는 방법이 있다. 이 증례는 외상으로 인하여 상악 좌측 중절치가 함입되었다는 주소로 내원한 6세 7개월 된 여아에서, 함입된 치아의 자발적인 맹출을 기대하였으나 맹출이 되지 않아서, 교정적으로 견인하여 맹출시킨 경우로 양호한 결과를 얻었기에 이를 보고하는 바이다. Traumatic intrusion is a type of injury that involves axial displacement of a tooth toward the alveolar bone. Its occurance is relatively rare compared to other types of luxation in permanent dentition. It is more common in boys than in girls, and most common etiology of intrusion is fallen down. Various complication may occur following traumatic intrusion, such as pulp necrosis, root resorption, pulp obliteration and marginal bone loss. In addition, traumatic intrusion is commonly combined with hard or soft tissue injuries. Therefore, it is difficult to establish proper treatment plan. Choice of treatment for an intruded tooth by trauma include waiting for spontaneous re-eruption, orthodontic repositioning, and surgical repositioning. In this case, we repositioned the intruded central incisor using orthodontic traction, in a six-year old girl, which failed to re-erupt spontaneously.

상악 정중부에 역위 매복된 과잉치의 악골 내 이동

이석우,이제호,김성오,최형준,손홍규,최병재 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.4

과잉치는 상악 정중부에서 주로 발견되며,과잉치의 발생 기전은 유전적 또는 환경적 원인에 의하여 치배 형성기 동안에 정상 치판의 비정상적 증식에 의한 것으로 보고되었다. 과잉치로 인한 합병증으로는 인접 영구치의 맹출 장애와 전위,회전,정중이개,비강으로의 맹출,낭종 형성 등 이 있다. 과잉치를 외과적으로 발거하기 위한 시기에 대해서는 논란이 되고 있다. 인접치의 배열과 맹출 장애,전위를 야기할 수 있기 때문에 조기에 발거하자는 견해와 어린이의 행동 조절 및 인접 영구치의 치근 형성 정도를 고려하여 8~l0세 이후에 발거 하자는 견해가 있다. 후자와 같이 외과적 발거 시기를 연기할 경우,역위 및 수평 매복된 과잉치는 악골 내에서 비강 또는 경구개,소구치 부위 등으로 이동할 수 있으며,과잉치의 이동과 전상악골의 수직고경 증가로 인하여 외과적 발거 시 난이도가 높아질 수 있다. 따라서,역위 및 수평 매복된 과잉치의 외과적 발거 시기를 결정하기 위하여 연기하는 경우에 과잉치의 악골 내 이동을고려해야한다. 이 증례는 상악 정중부에 역위 매복된 과잉치가 있어서 내원한 6~7세의 어린이에서 과잉치의 외과적 발거 시기를 결정하기 위하여 주기적인 방사선 학적 검사로 관찰하던 중에 2~3년 후 과잉치 위치가 악골 내에서 초진 시 위치로부터 이동된 경우로 이를 보고하는 바이다. Supernumerary teeth are frequently found in the anterior portion of the maxilla and develop as a result of abnormal proliferation of the dental lamina during tooth germ formation, caused by genetic or environmental factors. They may result in various complications, such as eruption interference, displacement, rotation of adjacent teeth, diastema, eruption into the nasal cavity, and development of dentigerous cyst. The optimal time for surgical extraction of supernumerary teeth has been a controversial issue. Someone prefer early surgical extraction because supernumerary teeth can cause eruption interference and displacement of adjacent teeth, eventually altering occlusion. Others prefer to delay surgical extraction until 8~10 years of age in consideration of root maturation of the adjacent teeth and also patient's behavior. When surgical extraction of supernumerary teeth is postponed, there is possibility that impacted supernumerary teeth in the inverted or horizontal position move toward the nasal cavity, hard palate, or premolar area. When such intraosseous tooth migration is combined with the vertical growth of the maxilla. surgical approach becomes even harder. Therefore, possibility of intraosseous tooth migration should be considered as an important factor when deciding appropriate time for surgical extraction. We are presenting cases of mesiodens which showed intraosseous migration during 2~3 years of follow-up period since the first diagnosis had been made at the 6~7 years of age.

설측으로 수평 맹출한 하악 측절치의 교정적 견인

김성오,마연주,손흥규,최병재,이제호 大韓小兒齒科學會 2010 大韓小兒齒科學會誌 Vol.37 No.1

Tooth eruption is the movement of the tooth from the developing place in the alveolar bone to the functional position in the oral cavity. The permanent incisors originate from the dental lamina on the lingual side of preceding deciduous tooth and erupt to the level of the occlusion through the well developed gubernacular cord. Ectopic eruption is a developmental disturbance in the eruption pattern of the permanent dentition. Most of the ectopically erupted lower incisor has been found in lingual side. The ectopically erupted tooth could be repositioned by orthodontic force in the early mixed dentition, which could help preventing the problems of loss of space and the lingual tilting of the lower anterior teeth. An eight-year-old girl visited the department of pediatric dentistry, Yonsei Dental University Hospital, for the evaluation and the treatment of the lower right lateral incisor, which was horizontally erupted in the lingual side, parallel to the mouth floor. Her tongue was placed on the labial side of that tooth. There was no previous dental history of dental caries or trauma on the pre-occupied primary incisor. Clinical and radiographic examinations including the computed tomography(CT), showed no evidence of dilacerations on root. Therefore, we decided to start active orthodontic traction of the lower right lateral incisor. We designed the fixed type of buccal arch wire and the lip bumper with hook for the traction. Button was attached to the lingual side of the ectopically positioned tooth. Elastic was used between the appliance and the button on that tooth. After the tooth become upright over the tongue level, appliance was change to the removable type and periodic check-up with occlusal guidance was followed to monitor the position of the tooth. In this case using the fixed appliance with modified form of lip bumper and hook embedded in acrylic part instead of extraction was very efficient up-righting the ectopically erupted tooth toward the occlusal plane. 치아 맹출이란 치아가 치조골 내의 발생 장소에서부터 교합면쪽으로 이동하여 구강 내로 출현한 후 치아의 기능적 위치까지 이동하는 것을 말한다. 유치의 치근부에서 발육하는 영구치배는 천천히 유치의 치근과 지지하는 치조골 부위를 흡수하면서 맹출하고, 이와 동시에 영구 치배의 치근과 치조골 및 기저골을 성장시킴으로써 영구치의 지지부위가 확립된다. 대개 영구전치의 치배는 유전치의 치근단 설측에 위치하는데 잘 발달된 도대삭(gubernacular cord)을 따라서 교합면상으로 맹출하게된다. 이소 맹출이란 일반적으로 치배가 본래 발생 위치에서부터 예상되는 정상 맹출경로에 이상이 있는 것을 말한다. 즉, 치아가 치조골 내 발생 위치에서 예측되는 정상맹출 경로를 벗어나 맹출하는 것이다. 그 중 하악 측절치의 이소 맹출의 경우 치아의 위치를 바로잡는데 있어서, 그 치료 시기가 중요한 요소로 여겨지는데 일반적으로 혼합치열기 초기가 바람직한 치료시기이다. 하악전치가 이소 맹출한 경우 적절한 시기에 치료를 시행함으로써 공간 소실의 문제나 하악 전치부의 설측경사 등의 문제가 발생하는 것을 예방할 수 있다. 본 증례는 만 8세 여아에서 혀 아래쪽의 구강저 부근에 수평방향으로 이소 맹출하는 하악 우측 측절치를 주소로 연세대학교 치과대학병원 소아치과에 내원하였다. 컴퓨터 단층촬영(CT)을 이용하여 문제 치아의 치근 만곡 정도를 확인한 후, 혼합 치열기 초기에 lip bumper와 buccal arch를 이용하여 26주간 적극적인 견인적 처치를 시행하였다. 결과적으로 이소 맹출한 측절치를 본래 위치로 이동시켰으며 나머지 영구치의 맹출에 대한 관찰 및 평가 후 전반적인 교정치료를 진행하기로 계획하였다.

출생 시 발생한 특발성 치은섬유종증

이효설,최형준,최병재,손홍규,이제호 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.4

치은섬유종증(Gingival fibromaotsis)은 치은조직의 섬유성 증식을 나타내는 드문 구강질환이다. 원인은 명확히 규명되지 않았으나 상염색체 우성 또는 열성의 유전성이거나 특발성일수 있다. 주로 영구치 맹출 시기에 나타나기 시작하나, 드물게 유치열기나 출생시부터 이환되는 경우도 있다. 치은은 서서히 증식하여 치아의 해부학적 치관부위를 덮거나 구개 변이를 일으켜 혀 운동장애를 야기하거나 입술 폐쇄를 방해하기도 한다. 이 증례의 환아는 14개월 된 여아로 출생 시부터 계속딘 치은증식을 주소로 내원하였다. 특별한 가족력이나 의학적 병력은 없었고, 임상 유전검사 결과 알려진 어떤 증후군으로 진단되지 않았으나, 신체발달이 지연되어 있었다. 펀치 생검을 하였으며, 조직검사명은 치은섬유유종증이었다. 가족력이 없어 특발성 치은섬유종증으로 진단하였다. 환아의 연령 및 전신 상태를 고려해 치은 절제술 등의 외과적 치료는 연기하기로 하였다. Gingival fibromatosis is a rare condition characterized by varying degrees of gingival hyperplasia. Gingival fibromatosis usually occurs as an isolated disorder or can be associated with a variety of other syndromes. It usually appears at the time of eruption of permanent dentition but, can develop at the time of eruption of the primary dentition and rarely at birth. It may deform palatal contour and subsequently restrict the tongue movement, resulting in interference during speech and mastication. In addition, it incapacitates maintenance of normal lip closure. A 14-month-old girl visited the department of pediatric dentistry, Yonsei University Dental Hospital, for the congenital gingival overgrowth. There was no one in the family, who showed similar pattern of gingival growth. The intraoral clinical examination revealed generalized severe enlargement throughout the maxillary and the mandibular arches. Enlarged gingival tissue was pink and had firm consistency. She was referred for chromosomal analysis, which confirmed absence of any known syndrome. Under local anesthesia, "Punch-biopsy" was performed on the labial area, and the specimen was histologically diagnosed as gingival fibromatosis. For she did not have any medical problem nor familiar history, she was diagnosed as having idiopathic gingival fibromatosis. Regarding her age and behavior, close follow-up was decided.

정신과를 방문하는 환자의 통증호소의 빈도 및 특성

송지영,박진철,박종학,오동재,손형석,정근재 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

연구목적: 정신과 방문 환자에서 통증 호소는 적지 않을 것이라고 알려져 있으나 국내에서 정신과 외래 환자의 통증 관련 연구는 부족한 실정이다. 이에 정신과 외래에 오는 환자들에서 통증의 빈도와 특성을 1,2,3차 의료기관에서 알아보고자 하였다. 대상과 방법: 1차 의료기관(개인정신과의원) 외래환자 298명, 2차 의료기관(종합병원) 정신과 외래환자 99명, 3차 의료기관(대학병원) 정신과 외래환자 446명으로 총 843명의 성인 남녀를 대상으로 이들이 정신과에 방문했을 당시의 통증 여부와 조사 당시의 통증 유무 및 현재 통증의 정도를 평가하였다. 그리고 기질적 원인의 여부, 만성 통증의 여부, 통증의 부위, 통증 악화 요인, 보상문제의 유무, 약물 투여 내용 등을 조사하였다. 결 과: 1) 전체 대상자 843명 중 통증이 동반되었던 환자의 비율은 41.3%였으며, 기관별로 보면 개인의원 44.9%, 종합병원 44.5%, 대학병원 38.1%였다. 2) 조사 당시에 통증을 갖고 있는 경우는 3개 기관에서 평균 24.1%였다. 통증의 정도는 VAS상 평균 46.7㎜였으며 개인의원에서 대학병원에 비해 의미있게 그 정도가 심했다. 또한 `강하다` 이상의 통증 정도를 호소한 경우는 34.0%, `괴롭다` 이상의 불쾌정도를 표현한 경우는 26.2%였다. 3) 통증이 있었던 환자 중 기질성이 뚜렷한 경우는 적었으며(1.5∼5.9%), 통증의 부위는 머리가 50.9%로 가장 많았다. 통증의 지속기간은 6개월 이상인 만성통증의 경우가 68.7%를 차지했다. 4) 주요 약물로는 항불안제가 41.4%로 가장 많이 사용되고 있었으며, 통증과 관련하여 진통제를 처방받는 환자는 3.2%에 불과하였다. 결 론: 정신과 외래를 방문하는 환자들의 통증의 특성은 의료기관에 따라 인구통계학적 차이 뿐만 아니라 진단분포도 다르므로 3기관을 직접 비교하기에는 무리가 있으나, 본 연구 조사 결과 정신과 외래를 방문하는 환자들 중에서 40% 이상이 통증을 경험하고 있으며 2/3이상은 만성 통증이라 할 수 있었다. 이들은 중등도 이상의 통증을 갖고 있으며 당장 통증을 해결해 주어야 할 숫자도 적지 않았다. 따라서 정신과 환자의 통증에 대한 평가와 관리가 앞으로 더욱 강조되어야 할 필요가 있다고 사료된다. Objectives: The purposes of this study were to investigate the frequency and clinical characteristics of pain among the psychiatric out-patients in three clinics. Methods: A Total of 843 psychiatric adult out-patients(298 subjects from a private clinic, 99 subjects from a general hospital, 446 subjects from a university hospital) were assessed for the presence of pain during OPD follow-up and at the time assessed. And, the presence of organic causes, duration and site of pain, aggravating factors, compensation problems, and prescribed drugs were also investigated. Results: 1) The frequency of pain among psychiatric out-patients was overall 41.3%(44.9% in private clinic, 44.5% in general hospital, and 38.1% in university hospital, respectively). 2) The frequency of pain at the time assessed was 24.1%. In severity of pain, the average of VAS was 46.7±18.0㎜. Patients of private clinic showed more severe pain than that of general hospital. Moreover, patients who experienced over `marked` occupied 34.0% and pain as over `distressed` occupied 26.2%. 3) Only a few subjects had the definite organic causes(1.5-5.9%). The most common site of pain was on head. The patients having a pain over 6 months(i.e. chronic pain) occupied 68.7%. 4) The most common drugs prescribed were anxiolytics; 41.4% of patients were prescribed. The analgesics were prescribed only in 3.2% of patients. Conclusion: This result revealed that more than 40% of patients experienced pain in psychiatric OPD and two third of patients were suffered from chronic pain. Therefore, the evaluation and management of pain should be more emphasized.

백내장 수술환자 진료결과들간의 관계 : 사전 연구를 중심으로 Pilot study

박은철,김한중,홍영재,조우현,손명세,임승정,강형곤,최윤정 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.1

Background : This study was done to assess the relationship among multiple patient outcomes of cataract surgery perioperatively, 3-4 months and 12 months after surgery. The patient outcomes include changes in visual acuity(operated eye, better eye), visual function(VF-14), patient satisfaction, subjective satisfaction with vision, and subjective overall health status. Methods : For the assessment of relationship, prospective study was performed with 92 patients who had undergone either one or both eye cataract surgery by 3 ophthalmologists practicing at a university hospital. Patients were interviewed, and clinical data were obtained. Doctors were questioned with self-entered questionnaire forms. Medical record was examined to understand surgery process. The survey was conducted at 4 stages : preoperatively, perioperatively, postoperative 3-4 months, and postoperative 12 months. Results : The correlations within patient outcomes at 4 stages - the visual acuity of operated eye and that of better eye, patient satisfaction and VF-14, subjective overall health status and relative health status as against others - were found to be positively correlated. The change in the visual acuity of operated eye and better eye was correlated with VF-14 as well as with patient satisfaction. The change was also correlated with overall health status. However, the correlations between variables were decreased as the postoperative period got longer. Conclusion : As for the postoperative clinical patient outcomes, VF-14 is acted to linker between visual acuity - clinical outcomes and overall health status - endpoint outcomes. Therefore, VF-14 is the index of patient-sided and disease-specific outcome for cataract surgery.