위에 발생한 유암종 (Carcinoid Tumor) : 1예 보고

김남재,김진희,이경태,서광식,정현용,이승민,김석현,이병석,이헌영 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.3

A carcinoid tumor of the stomach is uncommon, has no clinical symptoms, and is regarded as a benign. It is also incidentally found in most cases. 48-year-old woman with gastric carcinoid tumor was admitted. She had suffered from a anorexia and a dry mouth for 4-months. A gastroscopy revealed a polypoid mass on the greater curvature of the mid-body of the stomach which was subsequently thought to be an adenocarcinoma. An endoscopic mucosectomy revealed however, that it was a carcinoid tumor. A case of carcinoid tumor of the stomach is here by presented with a brief literature review.

1. 06㎛ Nd : YAG Laser를 이용한 요추간판탈출증의 경피적 수핵감압술

이흥선,변박장,최순관,신원한,권귀향,이인수,이경석,김범태 순천향대학교 1994 논문집 Vol.17 No.4

The 1.06㎛ Neodymium-YAG Laser(800 micron hemisherical) is revealed a useful tool for percutaneous laser disc decompression(PLDD). Especially PLDD would be applied to the management of lumbar disc herniation with minimal intervention. Total irradiated energy to one level of disc space was bout 1000 to 2000 joules. We performed this method at 10 levels, in 7 cases of patients, consisting of 4 males and 3 females with an average age of 37.7 years. Five cases showed excellent and good results, were observed. In two cases, open surgery was required because of unsatisfactory results. The best results were obtained in the protrusion type of disc herniation. We have summarized some advantages of PLDD: a) safe and simple procedure in an outpatient setting, b) avoiding general anesthesia, late spinal instability, c) possibility of repetitive use.

장기입원환자 관리 방해요인

이경석,윤석만,권희,이호,김혜경,조미자,한규남,김명성 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Background: Recently the health insurance review agency tried to cut off the cost of unnecessary hospital stay. It is important to reduce the prolonged occupation of the hospital beds. However, there are some obstacles of the management for the prolonged bed occupation. We report our experiences and the problems of bed-control. Methods: To increase the rate of effective bed-usage, a task force was made. This team was consisted of 4 dctors, 2 nurses and 2 personnel of the administrative department. From December 20th 2001 to May 17th 2002, the task force analysed the rate, number and causes of the prolonged (more than 60 days, regardless of the disease entities) bed occupation. We announced and explained the necessity of bed-control and actively pressed to reduce the prolonged bed occupation. Results: The number of the prolonged bed occupation was 71 at the beginning of the management. It was reduced to 46 at best, then turned back to 65 at the end. It seems to be impossible to reduce the prolonged bed occupation until there are sufficient numbers of long-term care facilities. Aggressive bed control makes the sick patients to move every two or three months, it is never desirable. Conclusion: We cannot expect any Quality Improvements without improvement of the wrong system. Prior to the management for the prolonged bed occupation, it is necessary to build a sufficient number of long-term care facilities.

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.

경추손상의 형태와 원인

이용재,이경석 순천향대학교 1994 논문집 Vol.17 No.4

We present a series of 205 patients with cervical spinal injury. Those patients were treated at Soonchunhyang University Chonan Hospital during eight-year-period (January 1986-December 1993). We collected data on types and causes of cervical spinal injuries, and frequency of cord injury retrospectively. Most(74.1%) of the cervical spinal injuries occurred in those patients with 20-60 years of age, and the peak age was the third decade. Male to female ratio was 3.2 : 1. Upper cervical(C1, C2) spine was injured in 22.9%, and lower cervical (C3-7) spinal injuries constituted 69.3%. In 7.8%, there were spinal cord injuries without radiological abnormality(SCIWORA). C6 was the most common level of cervical spinal injury, followed by C2, C5, C7 in that order, and the injury was least common in C1, C2 shared 87.2% of the upper cervical spinal injury. In lower cervical spine, C5-7 shared 79.6%. The common causes of injury were passenger traffic accidents (48.8%), falls (28.3%), and pedestrian traffic accidents (11.7%). In upper cervical spinal injuries, falls were more common than pedestrian traffic accidents, vice versa in lower cervical spinal injuries. Anatomical sites of spine injuries were intervertebral joint in 43.4%, body in 43.4%, pedicle and lamina in 11.1%, and processes in 8.5%. In two cases (1.1%), penetrating injury was responsible to the cord injury. Intervertebral joint and body injuries were common in fall, and less common in pedestrian traffic injury. Lamina injuries were common in traffic injuries and less common in falls. Process injuries were common in pedestrian traffic accidents, and less common in falls. SCIWORA was least common in pedestrian traffic accidents. Common types of injury were odontoid process fracture type Ⅲ and hangman fracture in the upper cervical spine. In lower cervical spine, dislocation(32.4%), subluxation(10.6%), and fracture-dislocation(10.6%) were common types. Cord injury occurred in 103 patients (50.2%). The rate of cord injury was dependent to the level and types of spinal injury. Age, cause, and site of injury did not significantly affect the rate of cord injury. The rate of cord injury in the upper cervical spine was 29.8%, and it was 51.4% in thw lower cervical spine. Dislocation was the most common type of injury resulting cord injury (76.0%), followed by fracture-dislocation (68.8%), body fracture (34.8%), lamina fracture (33.3%) in that order. Victims who were aged, injured by passenger's traffic accident or fall, and injured at the joint revealed the higher rate of cord injury, but those differences were statistically not significant. We again confirmed that cord injury occurred in more than a half of the cervical spine injuries, and were most common in those 20-50 years of age, that is the most active and productive period of life. Cervical spine is the most common site of spine injury, and most cervical spine injuries were brought on by potentially preventable causes. To reduce the number of secondarily disabled persons, an effort to prevent traffic accidents, the most common causes, is required.

응급의료센터 과밀화 해소를 위한 환자 전원

이경룡,구홍두,박인철,김승환,장석준,심호식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

To reduce the degree of overcrowding in level Ⅲ emergency care centers, authors have conducted a prospective study of patient who were transferred to level Ⅰ or Ⅲemergency center based on the non-emergent patient guideline currently used at the severance Hospital, level Ⅲ emergency center, during the period of 65 days from Jan. 1st 1995 to Mar. 6th 1995. Followings are guideline for non-emergent patient described by the Korean government low: 1) systolic blood pressure greater than 80/100 of normal. 2) respiration rate between 10 to 24 per minute. 3) pulse rate between 60 to 100 per minute. 4) body temperature between 36 to 37.5℃ by rectal. 5) relatively alert mental status. 6) patient not requiring emergency operation at the time of examination. The results were as follows: 1. Among the total 5,301 patients, 464 patients ranged from age of 1 to 82 years old were transferred to level Ⅰor Ⅱ emergency center after simple treatment. 2. Among the 464 patients, 276 patients were treated in expected hospital with medical problems in 101 (36.6%) patients, and 175 (63.4%) patients had surgical problems. 3. Among the 276 patients, 122 (44.2%) patients were admitted, 145 (52.9%) patients were discharged from the emergency room after adequate treatment. 4. Among the transferred patients, simple laceration (33.0%) were most common, acute gastroenteritis (12.0%), and simple contusion (10.5%) were followed. These results suggest that about 10% of patients visiting level Ⅲ emergency care center, can be safely transferred to nearest level Ⅰor Ⅱ emergency centers on the bases of non-emergent patient guideline described by Emergency Medical Service law. These guideline, if put into proper use, can reduce the degree of overcrowding problems in level Ⅲ emergency care center through out the country.

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.

폴리카보네이트 브라켓 부착 시 결합강도 증진을 위한 표면처리 효과

김석필,김년경,이현정,황현식 대한치과교정학회 2006 대한치과교정학회지 Vol.36 No.5

본 연구는 폴리카보네이트 브라켓 부착 시 표면처리가 결합강도를 증진시키는지 알아보고자 시행되었다. 소의 하악 중절치를 포매하여 만든 100개의 시편에 광중합형 레진 접착제를 이용하여 폴리카보네이트 브라켓(Alice, 광명 데이콤, 대한민국)을 부착하였다. 대조군의 경우, 표면처리 없이 부착한 반면, 실험군의 경우 샌드블라스팅 처리한 경우, plastic conditioner 처리하여 부착한 경우, 그리고 샌드블라스팅과 함께 plastic conditioner 처리한 경우로 구분하여 접착하였다. 만능시험기를 이용하여 전단결합강도를 측정하고 파절양상을 비교 분석한 결과, plastic conditioner나 샌드블라스팅으로 표면처리를 시행한 경우 표면처리를 시행하지 않은 경우에 비해 높은 결합강도를 보였다 (p<0.001). 샌드블라스팅과 Plastic conditioner를 모두 처리한 경우는 샌드블라스팅만이나 plastic conditioner만 처리한 경우보다 높은 결합강도를 보였으며, 특히 샌드블라스팅만 처리한 경우에 비해서는 통계적 유의차를 보였다 (p<0.05). 이상의 연구결과는 폴리카보네이트 브라켓 부착 시 결합강도 증진을 위해서 베이스의 표면처리가 필요하며 샌드블라스팅 후 plastic conditioner 도포가 가장 효과적임을 보여주었다. Objective: The purpose of this study was to evaluate whether the bond strength of polycarbonate brackets can be increased through surface treatment. Methods: One hundred polycarbonate brackets (Alice) were bonded to bovine incisors with light-cured adhesive. The bracket bases were treated with one of three methods; sandblasting, plastic conditioner application, and combined treatment with sandblasting and plastic conditioner. The brackets without any surface treatment served as the control. The shear bond strength was tested with a universal testing machine, and failure pattern was assessed with the adhesive remnant index. Results: The shear bond strength in all experimental groups was higher than that of the control group (p<0.001). The group treated with plastic conditioner after sandblasting showed statistically higher shear bond strength than the sandblasting only group (p<0.05). The group treated with plastic conditioner after sandblasting showed higher shear bond strength than plastic conditioner only group, but the difference was not statistically significant. Conclusion: The above results suggest that the surface treatments of polycarbonate bracket is mandatory to improve bond strength, and the most effective method is an application of plastic conditioner after sandblasting.

독성물질의 세포사 기전 및 세포사 유발물질의 검색법 개발에 관한 연구(Ⅰ) : 독성물질로 인한 파킨슨병 모델에서의 세포사 기전 연구 Study on the cell-death mechanisms of toxin-induced parkinsonism

강태석,김종민,서경원,김영옥,김준규,오재호,이윤동,김규봉,오정자,송연정,임종준,전범석,문전옥,최광식 식품의약품안전청 2000 식품의약품안전청 연보 Vol.4 No.-

MPTP 독성물질이 도파민성 신경세포에 선택적으로 작용하여 산화성 손상에 의한 신경세포사를 일으키는 것을 이용하여 파킨슨병의 동물모델을 만들고, 이를 통해서 아폼토시스를 비롯한 포사의 기전에 대한 연구 및 너코틴의 신경세포 보호효과 여부를 판정하는 실험을 병행하고자 하였다. 파킨슨꾐의 동물모델을 MPTf 독성 물질을 이용하여 확립하였으며, MPTP(30mgag, i.p.)를 투여한 후 1, 2,3, 4, 5일째 흑질 조직을 채춰하여 tarm로 박걸하여 tyrosine hydroxylase 면역조직화학염색을 수행하여 cell countif우한 결과, control은 57.635ce11s, 1일째 친.OfDells,2일째 57.9±6cells,3일릴 없.3±죠ells, 4일째 49.0츠3cells, 5일째 39.4±Scells료 4, 3일째 뚜렷한 신경세포 수의 감소를 보였다. 신경세포사 기전 규명을 위한 아폼토시스 분걱에서는 벼PTP 투여 후 1, 2, 3, 4, 5일째 조직을 채취하여 Hoechst staining, TUNEL staining을 수곡하였는데 양성 반응을 보인 신경세포는 관찰되지 않아. 아폼토시스로 인한 세포사가 관찰되지 않았다. bIPTP 파킨슨병 동물모델에서 nicotine 보호효과 탐색에 관한 실험은 nicat푸e 0.2mgAg을 5일 퐁안 투여 후 리『fP(30mgag)를 CS7Bt/6 마은스에 복강 내주사로 nicotine과 병용 투여한 후 1, 2, 3, 4, 5일째 뇌를 적출하땄다. 신경세포사가 뚜렷이 관찰되기 시작하는 4, 5일째의 신경세포 수의 감소 정도를 20. 30% 정도 약화시키는 경향을 보였으나, nicotine 보호효과에 대한 추가 실헝이 현재 수행 중에 있다. The cause of Parkinson's disease (PD) is largely unknown. However, free radical toxicit? may plaf a role ip. the degeneration of substantia nigra, which is the Hajorfocus of pathological damages in PD. Recently, a neuroprotective effect of nicotine in PD has been suggested. Therefore, the mechanism of neurodegenerafion and protective potential o( nicotine in PD were investigated in the experimental modeB of Pll using a neurotoxin, C57BL/6mice were administered with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 30 mg/kg,j.p.). The degree of neurodegenerafion was determined by immunohistochemical stainiHB oftyrosine hydroxylase (TH). TH-positive cells on nigral sections were found 56.0 ±4, 57.9 ±6,52.315ce11s, 49.0±3cells, and 39,4±Scells at days 1, 2, 3, 4, 5, respectively (controls : 57.6±Scells). Hoechst and TUNEL staining showed no evidence of apoptosis. The exandnation on themice co-adrunistered with nicotine(0.2mgAg) and MPTP(30mgag) revealed a tendency ofnicotine protective effects. At days 4 and 5, the degree of TH-positive cells was decreased by20-30%, In corclusiffn, the role of apoptosis was not evidenced in this MPTP modeB of PB.The possible proteccon by nicotine should be elucidated with further studies.

인터넷기반 안전한 의료 정보 유통/관리 프로토콜

박동규,이경석,염훙열,황유동 순천향대학교 부설 산업기술연구소 2000 순천향 산업기술연구소논문집 Vol.6 No.1

In this paper, we propose a secure electronic transaction and management protocol to provide user authentication, data integrity, confidentiality and access control for secure medical management system based on internet. We prove the validation of the proposed protocol by implementing it and testing it's fuctions.