60세 이상 환자의 척추수술

윤석만,이경석,도재원,배학근,윤일규 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Objective: Advances in surgical technique, anesthesia and perioperative patient management, coupled with the rapid increase in the population of patients reaching their 60s or older, have led to a signiticant rise in spinal precedures. The objective of this study was to evaluate frequency of the disease, surgical results and postoperative complications of the aged patients who underwent spinal surgeries. Methods : We reviewed all spinal procedures for spinal lesions including degenerative diseases, trauma, tumor and others in patients aged 60 years or older between January 1 1994 and October 1 1998(56 men and 26 women), retrospectively. Final outcome was assessed by telephone interview with the patient or the family in 67.1%(55/82). Results : There were 56 male patients and 26 female patients. There were 57 cases of degenerative diseases, 14 cases of trauma, 5 cases of metastaisis, 4 cases of infection and 2 cases of others. According to the level of surgical procedures, there were 20 cases fo cervical spine, 8 cases of thoracic spine, 54 cases of lumbar spine. Postoperaive complications included the following(17/82): 7 dural tears, 2 sepsis, 2 nerve root injury and 6 others. There were no operation-related deaths. During follow up period, ten patients(12.2%) had died, 45 patients(54.9%) were contacted and 27 patients(32.9%) could not be located. Mean follow up period for the 45 patients contacted was 26.1±15.7 months. Of the 45 persons contacted, 34(75.6%) reported improvement, 6(13.3%) no change and 5(11.1%) aggravation of their preoperative symptoms. Conclusion: Spine surgery in patients aged 60 years or older has higher complication rate compare to the younger but it is reasonable to consider the surgical procedures even in the elderly if it is needed. We should give attention not to tear the dura during the surgical procedures, especially in the elderly.

Pascal 프로그램을 위한 Syntax Tree의 설계및 구현

심재찬,이만호 충남대학교 자연과학연구소 1993 忠南科學硏究誌 Vol.20 No.1

Program transformation in source level is a base for parallel programming environment which helps programmer make good parallel programs. Abstract syntax tree is very good intermediate representation of source program to keep the syntax structure of source program. We design and implement the abstract syntax tree for Pascal program, and show the designed abstract syntax tree is good to use as an intermediate representation of Pascal source program by generating Pascal program with same syntax as source program from abstract syntax tree.

외상후 발작의 위험인자에 대한 조사

이재학,배학근,윤석만,도재원,이경석,윤일규,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Risk Factors for Posttraumatic Seizure The authors evaluate the risk factors for posttraumatic seizures. this prospective study was performed in a series of 470 head injured patient from January 1996 to Decomber 1998. The patients who were dead within 1 week of injury or children from 3 years old and under were excluded. There were 358 male and 112 female with a mean age of 35.2±22.8 years (range, 4-88 years). The results were as follows : 1). Of the 470 patients, pasttraumatic seizure occurred in 48 patients(10.2%): early seizure in 28(6%) and late seizure in 20 patients(4.2%). 2). The clinical risk factors for posttraumatic seizure were poor consciousness at admission, presence of brainstem herniation signs, poor GCS score, and posttraumatic amnesia more than 24 hours after trauma(p<0.001). 3). The radiological risk factors for posttraumatic seizure were subdural hematoma(p<0.001), intracerebral hematoma (p<0.02), mutiple intracranial CT lesions(p<0.001), or delayed lesions on follow-up CT scans(p<0.001). the incidence of seizure increased according to the severity of diffuse brain lesion(p<0.001), and the seizure rate in mass lesion was higher than that in diffuse lesion(p<0.001). 5). Hypoxia and coagulopathy had a statistically significant influence on posttraumatic seizure(p<0.05). Hypoxia had a infuence on occurrence of late seizure(p<0.05). 6). The incidence of posttraumatic seizure signiticantly increased in surgical group compared with coservative group(p<0.001) and significantly increased in patient who underwent decompressive craniectomy compared with those who underwent craniotomy(p<0.001) 7). Preventive administration of antiepileptic drugs decreased the incidence of early seizure, but did not affect on the reduction of late seizure. 8). Multivariate logistic regression analysis showed the subdural hematoma, GCS score, delayed lesion, and intracerebral hematoma in order of importance for seizure risk. in conclusion, the risk factors affecting on the occurrence of seizure were clinical status at admission, CT lesions, and severity of diffuse brain inJury. Considering that hypoxia affected on the late seizure, it is necessary to detect and treat it immediately after trauma. In addition, the patients who underwent decompressive craniectomy should be carefully followed to evaluate the risk of late seizure. Even though preventive administration of antiepileptic drugs had a tendency to decrease the incidence of early seizure, it is unclear whether administration of antiepileptic drugs can reduce the incidence of posttraumatic seizures. Prospective study will be needed in the selected patients.

G.Bu¨chner와 그의 作品에 나타난 女人像

박재만,박혜영 조선대학교 외국문화연구소 1996 外國文化硏究 Vol.19 No.1

두 번째 여성유형에 드는 Marion은 파리의 수락가 palais ,royal에서 창뇨두 번째 여성유형에 드는 Marion은 파리의 수락가 palais ,royal에서 창뇨 생활을 하는 특색 띈 여자로 제 1막 제 5장에만 등장하고 있다. Marion은 자기에게 놀러 온 Danton에게 독백조와 흡사한 말투로 자신의 반평생을 고백한다. Marion은 유년기부터 어머니에 의해 정절 교육을 받고 성서를 제외하고는 남녀에 대한 어떠한 책도 읽지 못하도록 지도받으며 성장한다. 그러나 그녀는 자신의 마음속 에서 소용돌이치는 본능에 눈뜨게 되고 성에 대한 호기심과 욕망으로 남자의 유혹에 넘어가고 남자와의 동침을 거듭하기에 이른다. 이러한 자신의 생활을 Marion은 다음과 같이 늘어놓고 있다. 『우리는 그 일을 남몰래 했어요. 그 일을 그렇게 계속했죠. 나는 모든 것을 삼켜버리고 점점 깊어만 가는 바다가 되는 것 이었어요‥‥ 내게는 남녀란 오직 성별 대립관계일 뿐이었죠. 모든 남자가 내 몸속으로 녹아 들어와 한 몸이 되어 버리는 거죠. 내 천성이 그랬으니까요. 이런 생각을 떨쳐버릴 수는 없었어요. ‥‥ 다른 사람들은 주일과 평일이 달라서 엿 세 동안은 일하고 일곱째 날에는 기도를 바치고 해마다 한번은 생일을 맞아 마음 설 레이고, 매년 한번쯤 새해에는 한해의 일을 곰곰이 생각도 해보죠. 나는 그까짓 것은 생각에도 없어요.

복벽 성형술의 문제점 및 분류

최희윤,류재만,김잉곤,차상면,엄기일 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.2

Some patients requesting abdominal contour surgery may have all their deformity below the semicircular line. These patients were treated by the traditional procedure, but these patients has nerve satisfied because of long and wide scar. From a study of the deformities of each layer of the abdominal wall, we have categorized three types of abdominoplasties. For each type, we used a different surgical technique, aiming to sculpture the abdomen and treat each layer according to the deformity present in each patient. By classifying the various problems and by using the different approaches, only the specific deformities of the abdominal wall need be corrected. The results were judged good excellent by the surgeons and patients because of the more natural appearance of the final results.

파노라마방사선사진에서 석회화가 발견되는 경동맥의 협착 정도

조소양,오원만,윤숙자,윤웅,이재서,Juan M. Palomo,강병철 대한구강악안면방사선학회 2009 Imaging Science in Dentistry Vol.39 No.3

Purpose : This study aimed to investigate the luminal stenosis of the internal carotid artery with calcification detected on panoramic radiographs. Materials and Methods : This study used fifty carotid arteries of 36 dental patients whose panoramic radiograph and computed tomography angiography (CTA) revealed the presence of carotid artery calcification. A neuroradiologist interpreted CTA to determine the degree of stenosis of the internal carotid arteries. The degree of stenosis was stratified in four stages; normal (no stenosis), mild stenosis (1-49%), moderate stenosis (50-69%) and severe stenosis (70-99%). Results : Among the fifty carotid arteries with calcification detected on both panoramic radiography and CTA, 20 carotid arteries (40%) were normal, 29 carotid arteries (18%) had mild stenosis, 1 carotid artery (2%) had moderate stenosis, and there was none with severe stenosis. Conclusion : Sixty percent of the carotid arteries with calcification detected on both panoramic radiography and CTA had internal luminal stenosis, and two percent had moderate stenosis. When carotid atheroma is detected on panoramic radiograph, it is possible that the dental patient has luminal stenosis of the internal carotid artery. (Korean J Oral Maxillofac Radiol 2009; 39 : 157-61)

모유 수유에 대한 일반인들의 인식에 관한 설문조사

반성환,이동환,박재옥,신상만 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.1

OBJECT : From the late in 1970, the incidence of breast-feeding have been increased in the developed countries. But, there is a marked contrast in Korea, inspite of the campaign of breast-feeding. We researched the general opinions of general populations on breast feeding to find out a better way on successful breast-feeding and helping people's understanding. METHODS : To find out the factors influencing the incidence of breast-feeding, we made on ingury study in 234 women and their family member including their husbands during the period of April, 1995 to August, 1995. We analysed the results according to sex, age, and the status of education and marriage. RESULT People in the inquiry answered as follows : - breast feeding is to be taken for granted.(93-94%) - the reason of breast feeding is for protecting baby from disease.(81-83%) - feeding breast milk is much better than cow's milk.(82-83%) - breast feeding is good for hepling the bonding between mother and her baby.(89%) - most of them would like to follow the spouse's opinion to keep on breast feeding.(73-75%) - breast feeding could cause some inconveniences in sexual-life/(74-78%) - breast feeding woman are regarded more admiarable when compared with non-breast feeding woman.(80-84%) - breast feeding woman is less attactive.(22-23%) - the purpose of creating breast is to feed baby.(14-17%) - breast feeding in public place is permissible.(43%) - breast feeding can make breast shapeless.(22%) CONCLUSIONS : Every effort should be made so as to increase the recognition of the value of breast feeding, not only for pregnant women but also for their husbands. Both of them have to attend the breast feeding education classes given before and after childbirth. Students have to be taught about the merit and the way of breast feeding through school education. Doctors are expected to encourage people to realize the advantages of breast-feeding, participate in the campaign and never advise to give up breast feeding.

절제된 백서의 좌골 신경에서 절제 원위부의 변화에 따른 신경재생의 비교 실험연구

김정태,엄기일,김잉곤,류재만,이혜성 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.2

성숙 백서 좌골신경의 분지전 근위부에서 7㎜가량을 절제하여 신경 간격을 만든뒤 실라스틱도관 근위단에 절단된 신경의 근위부를 관통고정하고 원위부에는 아무것도 열결하지 않거나 좌골신경 절편, 종골건 절편, 안면신경 절편을 각각 관통고정시켜 제4주 및 8주에 신경 축색수를 대조군과 혹은 각 실험군끼리 비교하여 다음과 같은 결론을 얻었다. 1. 신경 절편을 연결헌 2,4군의 신경재생은 대조군과 거의 차이가 없었고(P>0.05) 아무것도 연결하지 않은 1군, 건절편을 연결한 3군에 비해 현격한 신경재생을 보였다.(P<0.01). 2. 신경 절편의공여부에 관계없이 2,4군의 실험군에서 각각 비슷한 신경재생을 보여 일단 신경이 손상되면 신경 성장인자가 손상된 신경단으로 부터 분비되며 종류에 관계없이 그 근위부의 신경 재생을 자극할 수 있음을 알 수 있었다. 3. 건절편을 연결한 3군의 실험군에서는 일부 신경재생이 일어나는 것으로 보아 여러가지 가능성을 제시할 수 있었다. 이상에서 같이 신경 재생에 대한 기전은 아직까지 밝혀지지 않고 많은 논란의 대상이 되고 있는 것이 사실이나 저자들은 이에 조금이라도 접근해보고자 본 실험을 시도하였고 많은 의문점이 제시되었으나 만족할 만한 결과를 얻었다. 앞으로 보다 더 세밀한 비교관찰과 많은 개체수를 이용한 실험이 필요하겠고 축색수 이외에도 수초의 두께, 수초와 축색의 비율, 유수 및 무수신경수의 비율등도 함께 비교하는 정확한 결과의 분석이 필요하리라 생각된다. An experimental model was presented for studying nerve regeneration over constant gaps of various distal stumps such as, empty tube(GroupⅠ), sciatic nerve segment(GroupⅡ), calcaneal tendon segment(Group Ⅲ), facial nerve segment(Group Ⅳ), to ascertain how the regenerating fibers of the proximal stump of the severed sciatic nerves of the rats are oriented and processed. In this experiment, the silastic tube was used as a guide to observe the sprouting of the regenerating fibers from proximal stump and then the regenerating fibers in the tubes were obtained and analyzed by light microcope, electron microscope and axon counts at 4 weeks and 8 weeks with the evoked action potential at 8 weeks. The results were as follows. 1. The axon counts of experimental group Ⅱ and Ⅳ with nerve segment stump were similar to those of their control groups(P>0.05) and were greater than those of experimental groupⅠ and Ⅲ(P<0.01). 2. The axon counts between the experimental group Ⅱ and Ⅳ were nearly indistinguishable and so nerve segments, irrespective of donor site in the same rat, induced the regenerating stimulus to their proximal stump of resected sciatic nerve. 3. In experimental group Ⅲ, the obtaining results of axon counts were not negligible, in spite of tendon stump, and the author could propose various possibilities. In conclusion, we could approach to the regenerating process of the nerve through the analysis of the above results but yet can not explain the exact mechanism. Anyway when the results are applied to the clinical situation, we would be helped much.

자발성 뇌지주막하 출혈 환자에서 최초 뇌실 크기의 임상적 의의

신일영,윤일규,윤석만,도재원,이경석,배학근,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

The purpose of this study is to invesetigate the clinical significance of initial enlargement of ventricle in the patients who had aneurysmal SAH. Of the total 821 patients with aneursmal SAH who were registerd in SAH data bank system between 1989-1999, 307 patients who had been already measured in the size of ventricle at the time of admission, were studied retrospectively. The size of ventricle was calculated by bifrontal index. Normal size of ventricle was defined as 30% or less, mild enlargement was defined as 31 to 39%, and moderate enlargement of vertricle was defined as more than 39% in bifrontal index. The sizes of ventricle using bifrontal index were analysed according to the age, sex, blood pressure, consciousness at admission, medical history of hypertension, location of ruptured aneurysm, Fisher's grade on CT(computerized tomography) scan at the time of admission, cerebral vasospasm, intraventricular hemorrhage (IVH), performance of external ventricular drainage (EVD), and prognosis at discherge. Chi-square test and ANONA were used in the statistical evaluation. The results were as follows : 1) Of the 307 patients, 235(76.5%) had a mild to moderate enlargement of ventricle at the time of admission (more than 30% in bifrontal index). 2) The size of ventricle was enlarged according to the increase of age (p<0.05). 3) In the patients who had ruptured aneurysm on anterior cerebral artery, the size of ventricle significantly increased and showed a higher incidence in mild enlargement compared with moderate enlargement of ventricle (p<0.05). 4) The size of ventricle increased in th patients who had IVH and the EVD was more frequently performed in th patients who had the enlarged ventricle associated with IVH (p<0.05). 5) In the patients who had high Fisher's grade, the size of ventricle had a tendency to increase, but there was no statistical significance. 6) In the patients who had poor prognosis, the size of ventricle had a tendency to increase, but there was no statistical significance. Conclusively, the initial size of ventricle was enlarged in th aged patients, ruptured aneurysm on anterior communicating artery, high FIsher's grade, patients associated with IVH. Considering those factors, prediction for the enlargement of ventricle size may help to treat the patients suffering aneurysmal SAH.

Profile^(Ⓡ), ProTaper™ 및 K^(3TM) Ni-Ti파일의 과기구 조작이 치근단공 변위에 미치는 영향

양현,양인석,황윤찬,황인남,윤숙자,김원재,오원만 대한치과보존학회 2007 Restorative Dentistry & Endodontics Vol.32 No.2

본 연구는 ProFile, ProTaper 및 K^(3)를 이용하여 과잉 기구 조작에 의해 근관 성형 시 근관의 만곡형태와 Ni-Ti 파일의 종류에 따라 치근단공이 어떻게 변위 되는지를 비교 분석하고자 시행되었다. 본 실험에서는 레진모형근관으로 J자와 S자의 근관 형태가 재현된 ENDO-TRAINING BLOC을 사용하였다. 근관 성형 기구로는 ProFile^(®), ProTaper™, K^(3TM)를 사용하였다. 총 60개의 레진모형근관을 사용하였으며, 사용된 레진모형근관 및 Ni-Ti 파일의 종류에 따라 10개씩 6개의 군으로 나누어 근관성형을 시행하였다. 근관 성형 전·후 이미지를 Image-analyzing microscope 100X를 이용하여 얻고 Photoshop 7.0 프로그램을 이용하여 중첩하였다. 이미지 분석 프로그램을 이용하여 근관 성형 전·후 치근단공의 중심으로부터의 직경 변화량과 면적을 측정한 결과 만곡된 근관의 성형시 치근단공이 주로 만곡의 외측으로 변위됨을 나타내며 ProFile이 ProTaper나 K^(3) 보다 통계적으로 유의성이 있게 작은 변화량을 나타내어 근관성형시 바람직한 기구임을 시사한다. This study was done to evaluate transportation of the apical foramen after 0.5 mm overinstrumentation by ProFile, ProTaper and K^(3) in simulated resin root canal. Sixty simulated resin root canal with a curvature of J and S-shape were divided into two groups. Each group consisted of three subgroups with 10 blocks according to the instruments used: ProFile^(®), ProTaper™, and K^(3TM). Simulated resin root canal was prepared by ProFile, ProTaper and K^(3) with 300 rpm by the crown-down preparation technique. Pre- and post-instrumentation apical foramen images were overlapped and recorded with Image-analyzing microscope 100X (Camcope, Sometech Inc, Korea). The amounts of difference in width and dimension on overlapped images were measured after reference points were determined by Image Analysis program (Image-Pro^(®) Express, Media Cybernetic, USA). Data were analyzed using Kruskal-Wallis and Mann-Whitney U-test. The results suggest that ProFile showed significantly less canal transportation and maintained original apical foramen shape better than K^(3) and ProTaper.