심부 매복 정중 과잉치 수술 시 마취방법 선택

민수영,송제선,이제호,최형준,손흥규,김성오 大韓小兒齒科學會 2012 大韓小兒齒科學會誌 Vol.39 No.1

Supernumerary tooth occurs most frequently at premaxilla area. Followed by mandibular premolar area, mandibular fourth molar area, maxillary paramolar area. Mesiodens are mainly impacted in the palatal area and surgical approach is made at palatal side. The time of surgery remains controversial. In case of inverted or horizontal impacted supernumerary tooth, intraosseous tooth movement and vertical growth of premaxilla makes surgical extraction more difficult. And also the more quantity of removed bone is, the higher degree of difficulty is. Inverted mesiodens of these cases were impacted superior to apex level of adjacent permanent incisor. Although CT examination revealed exact location of impacted tooth, surgical procedure including ostectomy may take a long time more than expected. So, before surgical extraction, it’s need to be considered several factors such as necessity of CT taking, degree of difficulty, direction of surgical approach, necessity of general anesthesia etc. 정중 과잉치(mesiodens)는 대개 상악 절치부에서 발견되며, 주로 구개측에 위치하는 경향이 있다. 정중 과잉치의 자연맹 출 가능성이 관찰되면, 주기적으로 검사하여 구강내로 충분히 맹출한 후에 단순발치를 시행한다. 주기적 검사에서 자연맹출 소견이 보이지 않거나, 형태이상 혹은 맹출방향의 이상으로 구강 내로 자연맹출 할 가능성이 없으면, 수술적 제거방법을 고려 해야 할 것이다. 특히, 인접한 중절치나 측절치의 맹출을 방해하고 있는 상황이 관찰된다면, 빠른 시일 내에 과잉치 제거를 위 한 수술적 방법을 시도하는 것이 타당하다. 한편, 외과적 수술의 시기를 늦추는 것을 고려해야 하는 경우도 있다. 정중과잉치가 인접하여 발육중인 정상 치아의 맹출을 방해하지 않는 경우이다. 이때, 삼차원 CT사진을 촬영하여보면, 과잉치 주변으로 영구절치의 치배가 근접하여 성곽처럼 둘러 싸고 있는 것을 볼 수 있다. 미성숙한 치배가 둘러 싸고 있는 상황에서, 무리하게 과잉치를 제거하려고 시도할 경우 인접 치배 를 손상시킬 가능성을 배제하기 어렵다. 이 점을 고려 한다면, 가급적 인접한 치아의 치근이 보다 발육한 후에 수술을 시도하 는 것이 바람직할 것이다. 초등학교 2학년 이상의 어린이들은 외래에서 국소마취하 제거하는 수술방법에 대개 잘 적응하며 고학년이 될수록 보다 수월해진다. 수술시기를 너무 늦추거나, 과잉치가 너무 늦게 발견된 경우 구개측 심부로 깊이 이동한 것을 볼 수 있다. 때로는 과잉치의 위치가 처음부터 심부에 매복되어 있을 수 있다. 이와 같은 경우, 전신마취방법을 생각해 볼 수 있을 것이다. 본 증례는 상악 정중부의 깊은 부위에 역위 매복된 과잉치를 외래에서 국소마취하에 치료를 시도할 때 관찰되는 문제점을 고찰하였고, 전신마취방법을 결정하기 위한 기준을 제시하였다. 심부 매복된 치아의 외과적 발거시 어린이의 행동조절이 가장 큰 문제였으며, 방사선 소견상 과잉치 치관의 위치가 절치의 치근단보다 상방에 위치할 경우 전신마취로 전환 하는 것이 바람직 할 것으로 사료된다.

관상동맥내 스텐트 삽입후 발생한 관상동맥류 2례

제인수,허민영,문치숙,이재호,정수룡,조길현,이영민,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Coronary artery aneurysms are detected with increasing frequency because of the routine use of coronary angiography in the diagnosis and management of coronary artery disease. Although some coronary artery aneurysms are congenital or inflammatory, most are atherosclerotic. The prognosis of atherosclerotic coronary artery aneurysm may depend on the morphology of the aneurysm or the presence of coexisting obstructive disease. Coronary artery aneurysms have been also reported to occur after ballon angioplasty, directional athrectomy, laser angioplasty, and stent implantation with a frequency of 2% to 4%. The long-term outcome of post-intervention coronary artery aneurysm is unknown. We report two cases of the development of a coronary aneurysm 6 months after stent implantation as a treatment of severe obsructive coronary artery disease.

치주인대 세포의 교원질 생성에 대한 Substance P의 효과

전준영,최제용,경희문,성재현 대한치과교정학회 1996 대한치과교정학회지 Vol.26 No.1

Substance P는 교정력이 가해진 치아의 치주인대 중 인장력을 받는 부위에 많이 분포하는 neuropeptide 중의 하나이며, 또한 여러 조직에서 neurogenic inflammation을 야기하는 neuropeptide 중의 하나로도 알려져 있다. 그러나 중요한 세포의 단백기질인 교원질의 생성에 대한 Substance P의 효과는 잘 알려져 있지 않다. 따라서 이 연구의 목적은 배양 치주인대 세포에서 교원질 생성에 대한 Substance P의 효과를 평가하는 것이었다. collagenase-digestion method로 교원질 생성을 평가하였고 mRNA 수준에서 작용효과를 평가하기 위하여 Northern blot hybridization을 시행하였다. 이 연구는 또한 교원질 생성에 대한 prostaglandin과 gelatinase 생성도 포함하였으며 변성된 교원질의 분해를 평가하기 위하여 Zymography를 이용하였다. 비교원성 단백질, 교원성 단백질, 상대교원질에 대한 dose-dependent effect를 보면 Substance P는 비교원성 단백질 합성을 증가시켰으나 교원성 단백질 합성은 감소시켰다. 그리하여 총 단백합성에 대한 상대적인 교원질 생성을 나타내는 상대교원질은 7%에서 3.6%로 감소시켰다. 세포를 indomethacin과 동시에 처리할 때 substance P의 교원질 합성 억제효과는 나타나지 않았다. 이것은 Substance P의 교원질 합성 억제효과가 prostaglandin의 생성 때문이라는 것을 의미한다. Substance P의 교원질 합성 억제효과가 procollagen mRNA의 정상(steady-state)수준에 부합하는가를 평가하기 위하여 northern blot hybridization을 시행한 결과 Substance P는 α1(1) procollagen mRNA의 양적 변동을 일으키지 않았다. Substance P의 교원질 생성 억제효과는 전사이후의 어떤 단계에서 이루어지는 현상임을 나타낸다. 치주인대세포에서 gelatinase 생성에 대한 Substance P의 효과를 알아보기 위하여 zymography를 이용하였다. zymogram을 보면 Substance P는 치주인대세포에서 gelatinase 생성에는 아무 효과도 나타내지 않음을 알 수 있다. Substance P의 교원질 생성 억제효과가 치주인대세포에 대해 선택적인가 아닌가를 알아보기 위하여 MC3T3-E1세포를 이용하였는데 Substance P는 MC3T3-E1세포의 교원질 합성에는 영향을 미치지 않았다. 이상에서 Substance P는 인간의 치주인대세포에서 교원질 합성을 억제하였다. 이 효과는 procollagen mRNA와 gelatinase 생성의 정상(steady-state) 수준의 변화 때문이 아니라 prostaglandin 생성과 연관이 있음을 알았다. Substance P is one of the neuropeptide which presents highly in tension site of periodontal ligament during the orthodontic tooth movement. It has been also known as one of the neuropeptides which cause neurogenic inflammation in various tissues and organs. However, there is no report about the effect of substance P on major extracellualar matrix protein, collagen production. The purpose of this study was to evaluate the collagen production by substance P in human periodontal ligament cell, The collagenase-digestion method was used to evaluate collagen production and also used Northern blot hybridization for the evaluation of collagen mRNA level. This study also included in terms of prostanglandins and gelatinase production with respect to collagen production. For the collagen degradation, zymography was used to estimate denatured collagen degradation. Dose-dependent effect of substance P on noncollagen protein, collagen, and percent collagen was that substance P increased noncollagen protein synthesis, but decreased collagen systnisis. So the percent collagen, which determined by relative collagen production against total protein production, was decreased from 7% to 3.6%. This inhibitory effect of substance P on collagen production was disappeared when cells were treated concomitantly with indomethacin. It means that substance P-induced inhibitory effect on collagen production was due at least in part to the production of prostaglandins. To evaluate whether substance P-induced inhibitory effect on collagen production is correspond to the steady-state levels of procollagen mRNA, Northern blot hybridizartion was performed and it showed that substance P has no effect on the steady-state level of α1(1) procollagen mRNA. It means that the inhibitory effect of substance P on collagen production was due to the change of a certain mechanism after posttranscription. In this context, gelatinase production by substance P in periodontal ligament cells was evaluated by zymography. Zymogram showed that substance P has no effect on gelatinase production in periodontal ligament cells. To explore wheter substance P-induced inhibitory effect on collagen production is selevtive in periodontal ligament cells or not, MC3T3-31 cells which originated from mouse calvaria was used. It showed that substance P has no effect on collagen production in MCDTD-E1 cells. Taken together, substance P inhibits collagen production in human periodontal ligament cells. This effect was not due to the change of the steady-state level of procollagen mRNA and gelatinase production, but due at least in part to the change of prostaglandins production.

서울의 PPNG 발생 빈도(1991-1992)

김재홍,윤기범,박평원,김영진,전경민,김영태,김중환,곽호,구상완,송민석,유옥,지혜구,김동원,문상은,박영립,정승호,성범진,성순제,엄주용,황정열,이기홍,이주협,전태진 대한화학요법학회 1994 대한화학요법학회지 Vol.12 No.1

The prevalence of PPNG among pretreated gonorrhea cases isolated at the STD clinic of Choong-Ku Public Health Center in Seoul has been studied and reported annually since 1981. In 1991, 123 strains of N.gonorrhoeae were isolated, among which 58(47.1%) were PPNG. In 1992, 98 starains of N.gonorrhoeae were isolated, among which 51(52.0%) were PPNG. In all, 109(49.3%) strains were found to be PPNG among 221 strains isolated between 1991-1992. The prevalence of PPNG in Seoul showed increased tendency till 1989, thereafter, it has been stationary or slightly decreasing.

의도적 유치발치술에 의한 이소매복 영구치의 맹출유도

최인영,김승혜,김성오,최형준,이제호,최병재,손흥규,송제선 大韓小兒齒科學會 2011 大韓小兒齒科學會誌 Vol.38 No.4

맹출에 관계되는 여러 요소가 부정적으로 작용할 때 맹출장애가 유발될 수 있다. 맹출장애의 일종인 매복이 발생할 경우 주 기적인 관찰, 공간확보, 외과적노출, 교정적견인, 외과적노출과 교정적견인의 병행, 발거 후 자가치아이식 등의 방법을 고려 할 수 있다. 첫 번째 증례는 9세 남환에서 상악 좌측 측절치의 수평매복을 발견하여 상악 좌측 유측절치 및 유견치를 발거 후 5개월 뒤 개창술(window opening)을 시행한 증례로, 8개월의 정기검진시 치아가 부분맹출 하였으며 18개월 후 매복된 상악 좌측 측 절치가 치축이 개선되며 자발적으로 맹출하였다. 두 번째 증례는 10세 남환에서 상악 우측 제1소구치의 이소매복을 발견하여 상악 우측 제 1 유구치를 발거한 증례로, 10개월 뒤 치아가 부분맹출하였으며 19개월 후 매복된 상악 우측 제1소구치가 자발 적으로 맹출하였다. 본 증례들에서 이소매복된 영구치는 맹출경로에 있는 유치의 의도적 발거 후 경과관찰을 한 결과 맹출 위치의 개선 및 자발 적 맹출이 유도되었기에 보고하는 바이다. When many factors involved in the eruption of the teeth act as negative effects, they can cause eruption disturbance. Periodic observation, space acquirement, surgical exposure, orthodontic traction, orthodontic traction accompanied with surgical exposure, and surgical repositioning are considered as the treatment options of an impacted tooth, which is a form of eruption disturbance. In the first case, a male patient, age 9, visited Yonsei University Dental Hospital (YUDH) with a chief complaint of ectopic impaction of the upper left lateral incisor. We extracted the upper left primary lateral incisor and primary canine, and 5 months later, a window opening procedure was executed. Eight months later, the upper left lateral incisor partially erupted, and 18 months after the extraction, the axis of the tooth improved and the tooth erupted spontaneously. In the second case, a male patient, age 10, visited YUDH with a chief complaint of ectopic impaction of the upper right first premolar. We extracted the upper right first primary molar. Ten months later, the upper right first premolar erupted partially, and 19 months after the extraction, the upper right first premolar erupted spontaneously. We reported two cases in which improvement of eruption path and spontaneous eruption of an ectopic impacted tooth was achieved by extracting the deciduous tooth which interfered with the proper eruption of it.

소음 노출 남성 근로자의 고음영역 청력손실과 관련 요인

정상재,우극현,박완섭,유재영,최태성,김상우,김진석 대한산업의학회 2000 대한직업환경의학회지 Vol.12 No.2

Objectives : The purpose of the study was to assess the risk factors assumed to be related to the high frequency hearing loss in the noise-exposed male workers. Methods : 712 occupationally noise-exposed male workers were included in this cross sectional study. The subjects filled out a questionnaire on the history of noise exposure, hearing protection, otologic diseases, tobacco smoking, and were tested on height, weight, hematocrit, serum total cholesterol level, fasting plasma glucose level and arterial blood pressure level. Pure tone audiometry and otoscopy were conducted and the subjects were allocated into two groups according to whether they had 4000 Hz hearing loss or not. Results : The multiple logistic regression analysis showed that military noise exposure, poor wearing status of the hearing protection devices, increased age, long noise exposure duration, mean arterial pressure less than 80mmHg, high fasting plasma sugar are the factors significantly related to high frequency hearing loss (P〈0.05). On the contrary, there was no significant relationship between noise intensity, body mass index, serum total cholesterol level, smelling and high frequency hearing loss. Low hematocrit was shown to be a significant factor with a p-value less than 0.1. Conclusions : High frequency hearing loss in the noise-exposed male workers is related to military noise exposure, use of hearing protection devices, age, noise exposure length, fasting glucose level and mean arterial pressure, in this order. Appropriate use of the hearing protection devices has a great impact on the prevention of the noise-induced hearing loss.

강우시 소옥천에서의 비점오염원 유출 특성

오영택,박제철,김동섭,류재근 한국물환경학회 2004 한국물환경학회지 Vol.20 No.6

The aims of this study are the characterization of runoff from nonpoint source, the analysis of the pollutant loads and an establishment of a management plan for nonpoint source of Okcheon. For this purpose the basin of the stream So-okcheon was selected to the investigated. During the period from May 29 to July 21 in 2003, the water automatic sampler system has been installed in Okkagkyo and parameters such as SS, COD, TOC, TP and TN were analyzed. The pollutants of nonpoint source seem to be washed out along the stream water in the beginning of rainfall, remain in water and cause the stream pollution. The runoffs during heavy rainfall, especially, much higher concentration of SS than those during dry period. With respect to the annual loading of pollutants of the nonpoint source, the COD was 124 ton/yr, TOC 396 ton/yr, TN 1,429 ton/yr and TP 4.2 ton/yr in the year 2002. With respect to the pollutants loading of the nonpoint source, the COD was 375 ton/yr(95% of the total COD loading of 394 ton/yr), TOC 844 ton/yr(96% of the tatal TOC loading of 876 ton/yr), TN 1,985 ton/yr(96% of the total TN loading of 2,062 ton/yr) and TP 37.1 ton/yr(92% of the total TP loading of 40.3 ton/yr) in the year 2003.

치상 돌기 골절의 전방 경유 나사못 고정술 치료 성적

김인영,김수한,이정길,김태선,김재휴,이제혁,강삼석 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.9

차체용 드로우 다이의 블랭크 홀더 굽힘 변형 해석

인정제,신용승,김헌영,김재우,송명환,박진수 한국공작기계학회 2000 한국공작기계학회 추계학술대회논문집 Vol.2000 No.-

The contact forces between die components for the drawing of large size automotive panels introduce elastic deflections of the die components. Due to the deflections, the gap between blank holder and die varies locally resulting in nonuniform material flow. Such a nonuniform die gap usually requires correcting operation, so called die spotting, which is time consuming trial and error process. To reduce the die spotting time, the optimization of the blank holder bending deflection is needed. In this paper, we implemented an analysis procedure to predict the blank holder deflection. The analysis procedure and design of experiments techniques are applied to the optimization of balance block heights. The optimization results can be used as guidelines in actual die spotting process.

Caffeic Acid의 ONOO^(-) 제거활성

이지영,성도유,노재경,김유정,제정환,김민선,최재수,정해영,이경희 대한암예방학회 2003 Journal of cancer prevention Vol.8 No.3