사후분해 시체에 대한 법의학적 접근

최영식,이상용,김유훈,조갑래,이봉우,양경무,정낙은,서중석,이한영,이원태,강현욱 大韓法醫學會 2000 대한법의학회지 Vol.24 No.2

Disposal of a homicide victim by dismemberment is rare, but individual cases are on record in most major medicolegal departments. Recognition of postmortem mutilation may be of importance in the interpretation of certain murders committed by sexual perverts and other mentally deranged individuals and sometimes performed for the sole reason of easier disposal of the body. Postmortem dismemberment is usually readily recognizable as such; The edges of the injuries are dry and lack evidence of bleeding. The joints may be disarticulated without fracture, or the use of an axe or saw may be evident from examination of bones. Parallel horizontal or oblique furrows in the bone surface are caused by skipping of the saw prior to establishing depth. Such patterns on the bone may assist in identifying the particular saw involved. So we report 25 dismembered corpses that autopsied in National Institute of Scientific Investigation. This paper can help in attempting to establish not only the first criminal investigation steps but also the medicolegal approach methods in unidentified and dismembered deaths.

기관내 삽관시 Flexiblade 후두경과 Macintosh 형 후두경 사용에 대한 비교

장선영,이상귀,이준례 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.3

Comparison between the Flexiblade Laryngoscope and the Macintosh Blade Laryngoscope in Endortracheal Indubation Sun-Young Jand, M.D., Sang-Kyi Lee, M.D., and Jun-Rae Lee, M.D. Department of Anesthesiology, Chonbuk National University Medical School, Jeonju, Korea Background: The Flexiblade laryngoscope has a unique structure that is composed of a blade and a handle with a trigger. When the trigger of the Flexiblade laryngoscope is squeezed, the hyoepiglottic ligament is depressed, the epiglottis is moved anteriorly, and then the laryngoscopic grade is improved. This study was designed to compare the Flexiblade laryngoscope with the conventional Machintosh blade laryngoscope in the laryngoscopic view in endotracheal intubation. Methods: Following induction of general anesthesia, the laryngoscopic grades of 110 patients were evaluated while five different blade positions of the Flexiblade laryngoscope and a laryngoscopy with the Macintosh blade were performed. The laryngoscopic grades which were described by Cormack and Lehane were classified from 1 to 4. Results: With the Macintosh blade laryngoscope, 98.2% of the patients were grade one and two, and 98.2% of the patients was laryngoscopic grade one and two with partial depression of the trigger of the Flexiblade laryngoscope. The laryngoscopic grade of maximal depression of the Flexiblade trigger had similar results to partial depression of the trigger. However, the partial depression of the Flexiblade laryngoscope showed better laryngoscopic views than the maximal depression of the Flexiblade laryngoscope or the Macintosh blade laryngoscope, respectively. In the overall success rate of endo-tracheal intubation and using the adjusting maneuvers, the Flexiblade laryngoscope was superior to the Macintosh blade laryngoscope. Conclusions: The Flexiblade laryngoscope is comparable to the Macintosh blade laryngoscope for endotracheal intubation, therefore, the Flexiblade laryngoscope can be recommended as the first choice for endotracheal intubation. (Korean J Anesthesiol 2001; 41: 289~296)

당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.

Rocuronium의 애별투여방법이 모지내전근의 이완에 미치는 영향

최영균,김승수,이원진,조광래,이상은,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 인제대학교 2009 仁濟醫學 Vol.30 No.-

Objective : There are controversies in pnmmg technique of rocuronium whether it can or can't shorten the onset time. We want to compare the effects of two different priming doses and intervals of rocuronium. Materials and Methods : After giving propofol, 50 patients were randomly assigned to 5 groups. Group I received a placebo, followed 3 min later by rocuronium 0.6 mg/kg. Priming doses and intervals of Group II, Ill, N, V were 0.06 rng/kg and 2 min, 0.12 mg/kg and 2 min, 0.06 rug/kg and 3 min, 0.12 mg/kg and 3 min, respectively. Total dose of rocuronium was 0.6mg/kg. Train of four (TOF) count or ratio and 1st twitch height of TOF (T1) were monitored with 15 secondsintervals. TOF ratio of each groups just before bolus injection, duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were compared. Results : Duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were decreased in priming groups compared to Group 1 (P < 0.01) In group V, significant depression of TOF ratio just before bolus injection was seen (P < 0.05). Conclusion : Priming technique with rocuronium is effective method to shorten the onset of neuromuscular block. But priming dose of rocuronium itself could cause hypoxia and aspiration in awake patients and should be used carefully. Priming dose of rocuronium 0.06 mg/kg and 2 minutes interval maybe relatively safe method.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

심폐소생술시에 호기말 이산화탄소 분압 측정의 이용

이준희,안성태,김경래 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The effectiveness of ongoing cardiopulmonary resuscitation (CPR) efforts is difficult to evaluate. During a cardiac arrest and attempted resuscitation, there are no readily available noninvasive measurements that identify patients who are likely to have return of spontaneous circulation (ROSC). A number of studies in animals and humans suggest that systemic perfusion during arrest and CPR is related to the end-tidal volume of carbon dioxide, which is an indirect measure of pulmonary perfusion. A clinical study was done to determine whether endtidal carbon dioxide (PetCo₂) monitoring during CPR could be used as a prognostic useful noninvasive indicator of resuscitation and survival. The concentration of expired carbon dioxide was measured continuously with caphnography-BCI Model 9000 Caphnographer/Oximeter (Biochemical International, Inc., Waukesha, WI). to evaluate its clinical applicability, we performed prospective, bedside measurements of the PetCO₂in patients after cardiac arrest and during CPR. We measured the PetCO₂during 20 episodes of adult nontraumatic cardiac arrest and resuscitation in 16 critically ill patients during December, 1994 through February, 1995. Spontaneous circulation was restored in eight victims(40%). The mean PetCO₂of successfuly resuscitated group (ROSC, N=8, 23.6±5.5 mmHg) was higher than that of non-resuscitated group (non-ROSC, N=12, 8.7±3.0 mmHg) (p<0.05). the three patients survived more than 24 hours had a higher mean PetCO₂than that of the 17 patients survived less than 24 hours(28.0±6.0 vs 12.3±6.5 mmHg) (p<0.05). All eight patient who were successfully resuscitated had a PetCO₂of 15 mmHg or greater. No patient with a PetCO₂of less than 15 mmHg was resuscitated. We concluded PetCO₂monitoring during CPR are correlated with resuscitation from cardiac arrest. We also propose that measurement of the PetCO₂may be a practical and noninvasive method for monitoring blood flow generated by precordial compression during CPR, and may be an almost immediate indicator of successful resuscitation.

석탄폐석으로 제조한 흡착제의 물리적 특성

이상인,송근호,오한기,김종수,이광래 강원대학교 부설 석재복합신소재 제품연구센터 1999 석재연 논문집 Vol.4 No.-

석탄폐석인 선탄폐석과 굴신폐석으로 흡착제를 제조하였으며, 탄화/활성화 조건이 흡착제의 물성에 미치는 영향을 조사하였다. 탄화온도 500℃에서는 제조된 흡착제에 미세공이 형성되지 않았으며, 수증기법에 의한 850℃의 활성화 공정에 의하여 미세공이 생성되었다. 생성된 미세공에 의한 표면적은 전체 표면적의 약 50%를 차지하였다. 활성화된 흡착제의 표면적은 탄화과정만 거친 것보다 2.5배 더 컸다. 이는 활성화공정이 흡착제의 표면적에 미치는 영향이 매우 크다는 것을 의미한다. 굴진폐석으로 제조한 흡착제의 BET 표면적이 선탄폐석으로 만든 것보다 1.7∼2.9배 더 크게 나타났다. Coal waste-based adsorbents were prepared, and the effects of carbonization/activation conditions on the physical properties of the adsorbents were investigated. Two kinds of coal waste, coal-dressing waste and coal-dub waste, were used as raw materials. At carbonization temperature of 500℃, micropores were not formed in adsorbents. However, micropores was about 50% of total surface area. The surface area of activated adsorbent was 2.5 times greater than that of carbonized one. The BET surface area of coal-dub waste based adsorbents was 1.7∼2.9 times greater than that of coal-dressing waste based adsorbents.

측두하악관절에서 관절융기 형태와 관절원판 변위와의 연관성 연구

이흥기,황의환,이상래 대한구강악안면방사선학회 2001 Imaging Science in Dentistry Vol.31 No.3

Purpose : To investigate the hypothesis that the morphology of the articular eminence of the temporomandibular joint is a predisposing factor for disc displacement. Materials and Methods : MR images of 126 temporomandibular joints in 94 patients were analyzed to assess for morphology of the articular eminence and disc displacement. The displaced disc was further categorized as disc displacement with reduction(DDWR) and disc displacement without reduction(DDWOR). The morphology of the articular eminence was classified into four types; box, sigmoid, flattened, and deformed. The relationship between the four types of shape of the articular eminence and the two types of disc position was assessed. Results : In the DDWR and DDWOR groups, the morphology of articular eminence were a box type in 40.5%, a sigmoid type in 30.2%, a flattened type in 24.6%, and a deformed type in 4.7%. The box type of the articular eminence were 34.3% in the DDWR group and 42.9% in the DDWOR group. The sigmoid type of the articular eminence were 34.3% in the DDWR group and 28.6% in the DDWOR ㅎgroups. The flattuned type of the articular eminence were 28.6% in the DDWR group and 23.1% in the DDWOR group. The deformed type of articular eminence were 2.9% in the DDWR group and 5.5% in the DDWOR group. Conclusion : Disc displacement is more likely to be found in the temporomandibular joints with a box-shaped articular eminence, It can be considered that shape of the articular eminence is related to the development of disc displacement.(Korean J Oral Maxillofac Radiol 2001; 31 : 145-51)

레이저 초음파와 Wavelet변환을 이용한 재료표면균열 평가

이민래,최상우,이준현 한국비파괴검사학회 2001 한국비파괴검사학회지 Vol.21 No.2

비파괴 평가 기술들 중의 하나인 레이저 초음파 응용 기술은 각종 구조물에 존재하는 표면결함에 의한 신호를 통해 건전성을 평가하는 기법이다. 따라서 결함의 신뢰성 높은 정량적 평가를 위해서는 결함으로부터의 레이저 초음파 신호특성에 대한 기본적 이해가 필수적이며 따라서 이를 위한 신호해석 연구가 요구된다. 본 연구에서는 레이저 유도 초음파에 의한 one-sided 기법을 이용하여 표면균열을 평가하고자 하였다. 하지만 레이저를 이용한 평가방법들은 수신된 신호의 해석이 까다로우며 또한 상당한 전문적인 지식이 요구된다. 웨이블렛 변환(wavelet transform, WT) 기법은 신호처리 분야에서 하나의 새로운 방법으로서 다양한 분야에 적용되고 있으며 특히 한 시점에 대한 주파수 분해가 가능한 신호처리 방법으로서 시간-주파수 분석에 아주 유용하게 이용되고 있다. 본 연구에서는 이러한 레이저 유도 초음파를 이용하여 재료의 표면 결함신호들에 대한 웨이블렛 변환기법을 적용하여 보다 정량적인 결함 크기를 예측하고 그 타당성을 평가하고자 하였다. Laser-generated ultrasonic technique which is one of the reliable nondestructive evaluation techniques has been applied to evaluate the integrity of structures by analyzing the characteristics of signal obtained from surface crack. Therefore, the signal analysis of the laser-generated ultrasonics is absolutely necessary for the accurate and quantitative estimation of the surface defects. In this study, one-sided measurement by laser-generated ultrasonic has been applied to evaluate the depth of the surface-breaking crack in the materials. However, since the ultrasonic waveform excited by pulse laser is very difficult to distinguish the defect signals, it is necessary to consider the signal analyses of the transient waveform. Wavelet Transform(WT) is a powerful tool for processing transient signals with temporally varying spectra that helps to resolve high and low frequency transient components effectively. In this paper, the analyses of the surface-breaking crack of the ultrasonic signal excited by pulse laser are presented by employing the WT analyses.