A Prospective Study with Cage-Only or Cage-with-Plate Fixation in Anterior Cervical Discectomy and Interbody Fusion of One and Two Levels

Kim, Sam Yeol,Yoon, Seung Hwan,Kim, Dokeun,Oh, Chang Hyun,Oh, Seyang The Korean Neurosurgical Society 2017 Journal of Korean neurosurgical society Vol.60 No.6

Objective : The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods : A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs : subsidence, C2-C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results : In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups : however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425) ; fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion : Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

의무고용제도 재설계 방안

김종진,장창엽,유완식,김언아,이정주,류정진,강필수,최종철,남용현,김윤삼 한국장애인고용촉진공단 고용개발원 2008 연구개발 Vol.- No.2

현행 우리나라 의무고용제도는 장애인구의 급격한 증가, 장애인차별금지 및 권리구제 등에 관한 법률의 도입 등 외부환경변화에 신축적으로 대처하지 못하고, 경증장애인 중심으로 의무고용제도가 운영됨으로써 중증장애인의 고용배제가 우려되고 있다. 본 보고서는 이러한 문제점을 해결하기 위해 의무고용제도의 일자리 확대와 고용증가를 통해 중증장애인의 고용기회를 확대할 수 있는 정책방안을 제시하기 위한 것이다. 본 보고서는 (1)의무고용 사업체의 의무고용 산정인원에서 자립장애인 제외 (2)현행 2% 의무고용률을 3%로 상향 조정 (3)사업체가 고용하는 중증장애인에 대한 더블카운트(2배) 가산제도 도입 (4)의무고용률 미달 사업주에 대한 부담금 차등징수의 4가지 정책방안, 제도 합리화 차원에서 장려금 지급방식의 개선과 사업주의 장애인에 대한 인식개선 방안을 제시하였다. 정책방안에 대한 영향분석 결과 의무고용 적용대상자에서 비장애인과 고용상 차별되지 않는 자립장애인(6등급)을 의무고용 산정인원에서 제외하는 경우 의무고용 사업체의 고용인원은 23,296명이 감소해 고용률은 1.35%에서 0.88%로 감소하였고, 의무고용 사업체의 장애인 일자리 수는 미고용인원의 증가로 15,152개가 증가하였다. 그리고 기금은 부담금이 631억원 증가하고, 장려금이 352억원 감소해 983억원의 수지개선 효과가 발생하는 것으로 나타났다. 의무고용 사업주의 의무고용률 3% 인상 방안은 의무고용률 상향 조정에 따른 미고용인원의 증가로 장애인의 일자리 수는 43,101개가 증가하고, 기금은 부담금이 1,709억원 증가하는 반면, 장려금은 293억원이 감소해 2,002억원의 수지개선 효과가 발생하는 것으로 나타났다. 의무고용 사업주가 고용하는 중증장애인을 2인으로 더블카운트 하는 중증장애인 가산제도의 도입은 의무고용 사업체의 장애인근로자가 67,261명에서 79,685명(1,2등급만 포함시 75,685명)으로 증가하여 고용률은 1.35%에서 1.60%(1.2등급만 포함시 1.52%)로 증가하고, 의무고용률 미달 사업체의 미고용 인원이 감소하여 2,745개의 일자리가 감소하였다. 그리고 기금은 부담금이 118억원 감소하는 반면, 장려금은 418억원이 증가해 536억원의 수지악화가 발생하는 것으로 나타났다. 의무고용률 미달 사업체의 고용유인을 위해 고용률 1.0%미만, 1.0-1.5%, 1.6-2.0% 미만에 대해 각각 20%, 10%, 5%의 할증률을 순차적으로 가중하여 부과하는 부담금 차등징수 방안(3차년까지의 효과임)은 1.0% 미만 사업주는 86만원, 1.0-1.5% 사업주는 64만원, 1.6-2.0% 미만 사업주는 58만원의 부담기초액을 부과할 때 고용률은 1.35%에서 1.53%로 증가(1.6-2.0% 미만 사업주는 의무고용률 2%를 달성)하고, 미고용인원의 감소로 장애인의 일자리는 8,836개가 감소하는 것으로 나타났다. 그리고 기금은 부담금이 58억원 감소하여 수지는 악화되었다. 이상의 네 가지 방안은 모두 장애인의 고용증대를 가져온다는 측면에서는 유효하지만, 장애인의 일자리 확대를 통한 중증장애인의 고용을 증대한다는 정책목표를 달성하는 데에는 한계점을 안고 있기 때문에 어느 한 정책만을 선택하기보다는 정책효과를 극대화하기 위해 정책결합(policy mix)을 이용하는 것이 바람직함을 제시해주었다. 즉, 의무고용 적용대상자 조정방안/의무고용률 상향조정 방안과 중증장애인 가산제도/부담금 차등징수 방안을 조합 또는 모두 동시에 선택하는 경우 의무고용 사업체의 장애인 일자리 수의 확대와 중증장애인 고용을 동시에 달성하고, 기금의 수지균형도 달성 가능한 것으로 나타났다. The mandatory employment quota system of Korea does not reflect the changing external factors such as the growing population of people with disabilities(PWDs) and the enactment of the Anti-discrimination Law for People with Disabilities. The current employment quota system focuses on people with mild disabilities thus excluding people with severe disabilities from employment. The purpose of this report is to propose a plan in order to increase employment opportunity for the severely disabled through the reform of the employment quota system. This report analyzes the following : (1) exclude grade 6 disability from mandatory employment quota (2) raise the employment quota from 2% to 3% (3) implement the double counting for employers that employ the severely disabled (4) differentiate the amount of levy collected from corporations that are unable to meet the quota. The aforementioned plans are useful in that they increase employment for people with disabilities. However, there are limitation to reaching the policy objectives by increasing jobs for people with severe disabilities. Therefore, to maximize the effects we should consider policy mix of these four policies. In other words, by mixing the policies of adjusting the employment quota target/raising the quota ratio and implementing the double count/differentiating the amount of levy, we can achieve the goal of increasing jobs for the severely disabled and maintain equilibrium between incomings and outcomings.

경동맥 내막 절제술중 뇌보호와 신경생리학적 검사의 의의

신용삼,김선호,김종훈,민경태,김동익,유선국,이규창 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.8

Poster Session : PS 1239 ; Pulmonology : Azathioprine Induced Cholestatic Hepatitis in Patient with Boop

( Hyung Woo Kim ),( Joo Han Song ),( Kyung Soo Chung ),( Song Yee Kim ),( Eun Young Kim ),( Ji Ye Jung ),( Young Ae Kang ),( Young Sam Kim ),( Se Kyu Kim ),( Joon Chang ),( Moo Suk Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Azathioprine is widely used as an immunosuppressive drug in infiammatory bowel disease, many autoimmune disease and after organ transplantation to avoid rejection. Azathioprine has adverse reactions like hepatotoxicity. We report a case of azathioprine induced cholestatic hepatitis in patient with bronchiolitis obliterans organizing pneumonia(BOOP). A-37-year old woman was admitted because of pruritus and jaundice. She took transbronchial lung biopsy, bronchoalveolar lavage for cough, dyspnea and GGO patterns on chest computed tomography(CT) scan before she admitted. And it was revealed that she had BOOP. So she had been followed and treated for BOOP with prednisolone from 23th Nov 2012 and azathioprine from 8th Jan 2013. 42 days after taking Azathioprine, routine blood test was taken. Serum bilirubin, alkaline phosphatase(ALP), aspartate transaminase(AST), and alanine aminotransferase(ALT) was elevated(Bilirubin 4.4mg/dL, AST 75IU/L, ALT 104IU/L) and. Other laboratory test, including prothrombin time, serum albumin, and serum protein were within normal range. There was no history of alcohol abuse or herbal medication intake at this period. To exclude other reasons for hepatotoxicity, serological test was performed. The patient tested to negative for Hepatitis A, B, and C as well as for other markers of autoimmune hepatitis. CT scan showed hepatomegaly with lymph node enlargement and there was no evidence of bile duct obstruction. And TPMT(thiopurine methyltransferase) genotyping was done and revealed to be wild type. Azathioprine was stopped and she was monitored for laboratory changes. Because it was regarded as azathioprine induced cholestatic hepatitis and jaundice, we considered not to do liver biopsy. Day 55 after starting azathioprine therapy, total bilirubin reached peak (12.3mg/ dL). The patient was discharged on day 63 with cholestatic parameters of 115U/L(ALP), 36U/L(γ-GT), and 11.5mg/dL(total bilirubin). After 2 months, total bilirubin was decreased to normal(0.8mg/dL). Treatment of BOOP has been continued only with oral steroid.

75톤급 로켓엔진용 연료펌프의 축추력 측정

김대진(Dae-Jin Kim),홍순삼(Soon-Sam Hong),최창호(Chang-Ho Choi),김진한(Jinhan Kim) 한국항공우주연구원 2010 항공우주기술 Vol.9 No.2

축추력의 효과적인 제어는 터보펌프의 작동 안정성을 확보하는 데 중요한 기술 중 하나이다. 현재 개발 중인 75톤급 로켓엔진용 연료펌프에 대한 축추력 측정을 상온의 물을 매질로 하여 실시하였다. 시험 결과, 연료펌프의 축추력은 펌프 베어링의 축방향 하중 조건을 만족하는 것으로 예상되었다. 또한 연료펌프의 축추력은 대체로 유량이 작을수록 커졌다. 그리고 플로팅 링 실과 임펠러 사이의 간극이 바뀌었을 때, 연료펌프의 축방향 하중과 후방 누설 유량이 변화하는 것을 확인하였다. An effective control of the axial thrust of a turbopump is one of the critical issues for obtaining its operational stability. Axial thrusts of the fuel pump for the 75-ton class rocket engine under development were measured with water as a test propellant at a room temperature. According to the test results, the axial thrust of the fuel pump seemed to satisfy the axial force condition of its bearing. Also, the thrust was increased as a whole when the flowrate of the pump was decreased. Furthermore it was found that the thrust and the leakage flowate were modified when the gaps between the floating ring seals and the impeller were changed.

Surgical Causes of Significant Intraoperative Neuromonitoring Signal Changes in Three-Column Spinal Surgery

Wi Seung Myung,Park Sang-Min,Chang Sam Yeol,Lee Jeongik,Kim Sung-Min,장봉순,Kim Hyoungmin 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6

Study Design: Retrospective case series. Purpose: To evaluate the risks and causes of neurologic complications in three-column spinal surgery by analyzing intraoperative neurophysiological monitoring (IONM) data. Overview of Literature: Three-column spinal surgery, which may be required to correct complex spinal deformities or resection of spinal tumors, is known to carry a high risk of neurologic complications. However, few studies reported a specific surgical procedure related to a significant IONM signal change during surgery. Methods: Multimodality IONM data, including somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP), were reviewed in 64 patients who underwent three-column spinal surgery from 2011 to 2015. Surgical procedures included posterior vertebral column resection, pedicle subtraction osteotomy, total en bloc spondylectomy, piecemeal spondylectomy, and corpectomy with laminectomy (n=27) in three cervical, 34 thoracic, and 31 lumbar procedures. Results: Significant IONM signal changes occurred in 11 of 64 (17.1%) patients. SSEP and MEP were changed in 11 patients. Postoperative neurologic deterioration occurred in 54.5% (6 of 11) of the patients, and two of them were permanent. There was no postoperative neurologic deterioration in patients without significant signal change. Suspected causes of IONM data changes are as follows: adhesion/tethering, translation, contusion, and perfusion. Conclusions: Based on the results of this study, to enhance neurologic safety in three-column spinal surgery, surgeons should pay attention to protect the spinal cord from mechanical insult, especially when the spinal column was totally destabilized during surgery, and not to compromise perfusion to the spinal cord in close cooperation with a neurologist and anesthesiologist.

A Case of Occupational Hypersensitivity Pneumonitis Associated with Trichloroethylene

Jae, Young,Hwang, Eu Dong,Leem, Ah Young,Kang, Beo Deul,Chang, Soo Yun,Kim, Ho Keun,Park, In Kyu,Kim, Song Yee,Kim, Eun Young,Jung, Ji Ye,Kang, Young Ae,Park, Moo Suk,Kim, Young Sam,Kim, Se Kyu,Chang, The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.76 No.2

Trichloroethylene (TCE) is a toxic chemical commonly used as a degreasing agent, and it is usually found in a colorless or blue liquid form. TCE has a sweet, chloroform-like odor, and this volatile chlorinated organic chemical can cause toxic hepatitis, neurophysiological disorders, skin disorders, and hypersensitivity syndromes. However, the hypersensitivity pneumonitis (HP) attributed to TCE has rarely been reported. We hereby describe a case of HP associated with TCE in a 29-year-old man who was employed as a lead welder at a computer repair center. He was installing the capacitors on computer chip boards and had been wiped down with TCE. He was admitted to our hospital with complaints of dry coughs, night sweats, and weight losses for the past two months. HP due to TCE exposure was being suspected due to his occupational history, and the results of a video-associated thoracoscopic biopsy confirmed the suspicions. Symptoms have resolved after the steroid pulse therapy and his occupational change. TCE should be taken into consideration as a potential trigger of HP. Early recognition and avoidance of the TCE exposure in the future is important for the treatment of TCE induced HP.

참치 뼈를 이용한 Hydroxyapatite 세라믹 복합체의 합성 및 생체 친화성(제3보) : 인공체액에서의 Hydroxyapatite 세라믹 복합체간의 결합의 전자현미경 관찰 SEM Photographs of Bonding Properties between Hydroxyapatite Ceramics Composites in the Simulated Body Fluid

김세권,최진삼,이창국,변희국,전유진,이응호,박인용 대전산업대학교 반도체기술연구소 1999 半導體技術硏究所報 Vol.1 No.-

참치 뼈에서 추출한 hydroxyapatite를 출발물질로 여러 가지 세라믹 복합체를 제조하여 인공체액에서의 hydroxyapatite 복합체간의 화학결합을 조사하였다. hydroxyapatite 복합체들은 인공체액에서 4주 후부터 화학 결합성질을 나타내었다. 결합강도는 bioglass가 가장 강하게 나타났으며, 조성에 따른 의존성은 관찰할 수 없었다. 인공체액에서 복합체들은 이들의 경계면에서 불균일 핵생성 및 성장에 의해 화학적 결합으로 이루어졌다. Chemical bonding was investigated in the simulated body fluid of several selected hydroxyapatite-containing composites. The hydroxyapatite-containing composites chemically bonded with each other in the simulated body fluid after 4 weeks. Bioglass was strongly bonded in the simulated body fluid, but bonding strength was not depended on composition. Their composite bodies were chemically bonded by heterogeneous nucleation and growth at the interfaces of the specimens in the simulated body fluid.

외상성 흉·요추접합부 파열골절의 Kaneda 기구를 이용한 내고정술에 대한 임상적 검토 : Results of Anterior Decompression and Stabilization with Kaneda Device

장주호,김수한,정신,김재휴,강삼석,이제혁 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.4

The authors report clinical results of twenty-three traumatic thoracolumbar burst fractures treated by internal fixation with Kaneda device after anterior decompression during recent three years. Thoracolumbar injuries made up 28.9% of total spinal injuries and the burst fractures treated by anterior decompression and stabilization with Kaneda device constituted 19.0% of all spinal injuries. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were fall and vehicle accident. Superior end-plate fracture type was most common according to the types of burst fracture. The first and the second lumbar vertebrae were frequently involved. No patient showed neurological deterioration after surgery. Conus medullaris lesions in burst fractures of the thoracolumbar junction have a high potentiality for functional recovery because the lesions are not due to discontinuity or severe crush injury but due to simple compression by bony fragments. The Kaneda device offered enough stability to enable early ambulation with good alignment and solid fusion.

병렬 GHT 모델을 이용한 다중형태인식

金鎭浩,趙三模,高昌林 慶一大學校 1993 論文集 Vol.9 No.1

A parallel GHT model is introduced which can detect multiple shapes simultaneously with an efficient use of Hough space and modification of its accumulation method. In this method, we separated the Hough space into two and accumulated the evidences of reference points in two directions of up and down. The proposed model is implemented on the Transputer system and the resulted system proves to have simultaneous rotation-and scaling-invariant detection capability for four different shapes.