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구강암 수술 및 재건 환자에서의 C-Reactive Protein 수치의 변화
김철환,황승연,Kim, Chul-Hwan,Hwang, Seung-Yeon 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.5
Purpose: The aim of this study is that we evaluate the change of the White Blood Cell(WBC) count, Absolute Neutrophil Count (ANC), Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) values, and try to make standardization for postoperative sequels before and after the oral cancer resection and reconstructive surgery. Materials and Methods: The study was comprised of 34 patients (male 15, female 19) who were diagnosed as an oral cancer and had performed ablation and reconstructive surgery at Dankook university dental hos-pital. Each blood specimen was collected from patients and estimated WBC count, Neutrophil count, ESR, CRP on first, third, fifth, seventh day efore and after surgery and analyzing inter relationship between each value. Classifying Group I (resection with reconstructive surgery patients) and Group II (resection without reconstructive surgery patients). Also classifying group A (below 4 hours of operation time), Group B (4 to 8 hours of operation time), Group C (above 8 hours of operation time), each group was analyzed and compared. The Following results were induced. Results: (1) In coefficient of correlation, the CRP and WBC has highest value except WBC count and Neutrophil count. (2) There was no significant difference any lapse in the progress between Group I and II of WBC count, Neutrophil count, but the CRP shows statistically higher level in group I than group II at immediate postoperative day, and 1 to 5 days after surgery. (3) There is no significant difference any lapse in the progress between Group A, B, C of WBC count, Neutrophil count, but CRP shows statistically significant difference in 1 day, 3 days after surgery Conclusion: It should be suggested that, determination of CRP is most valuable parameter for postopera-tive management and determination of postoperative clinical changes than other parameter such as WBC count, neutrophil count, and ESR values in oral cancer patient after resection and reconstructive surgery, based on the results of this study.
김철환,김미숙,Kim, Chul-Hwan,Kim, Mi-Suk 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.4
Intermaxillary fixation is routine procedure to oral and maxillofacial area in jaw bone fracture, surgical correction of jaw deformity, osseus reconstruction of jaw. After transoral surgery, accompanied by intermaxillary fixation, dysphagia or airway obstruction may be followed due to blood clot, vomitus, or laryngeal spasm resulting from irritation by blood or secretions. Lingual or pharyngeal edema is other contributing factors of airway obstruction. In addition, intermaxillary fixation itself may cause obstruction of airway. In this study, pulmonary function test and arterial blood gas analysis were evaluated before and after intermaxillary fixation in 30 patients suffered from mandibular fractures. Comparative analysis was performed by estimated values. The results were as followed. 1. The spirometric values of FEV1, FEV1/FVC and FEF25-75% without intermaxillary fixation were reduced from 97.57%, 85.1%, 98.3,% to 71.7%, 66.5%, 61.2% with intermaxillary fixation, indicating the presence of obstructive pulmonary impairment. 2. Spirometric value of MVV, as the most influencing value of sensitive to extrapulmonary factors, was changed from 84.5% to 46.48%. 3. After intermaxillary fixation, the spirometric value of FVC, as indicator of restrictive pattern of pulmonary function, was not reduced significantly as measured from 94.47% to 89.97%. 4. $O_2$ saturation of arterial blood gas analysis without intermaxillary fixation was 97.86%. While intermaxillary fixation, $O_2$ saturation was 97.47%. The results indicate that careful airway management is mandatory undergoing intermaxillary fixation of various oral and maxillofacial surgery.
김철환,이경호 ( Chul Hwan Kim,Kyung Ho Lee ) 한국경제학회 1997 經濟學硏究 Vol.45 No.3
1970-1995년 사이의 연간 자료를 사용하여 한국의 재정적자와 대미달러 환율 사이의 관계를 실증적으로 분석한 결과 두 변수 사이에 공적분관계가 존재하는 것으로 나타났다. 오차수정모형을 사용하여 두 변수 사이의 인과관계를 추정한 결과 재정적자가 환율에 영향을 미치는 것이 아니라, 환율변동이 재정적자에 영향을 미치는 일방적인 인과방향이 장기적으로 존재하는 것으로 나타났다. 이제까지 우리 나라의 이자율과 환율이 각각 자본시장과 외환시장에서 결정되지 못하고, 정책적으로 결정되어 왔던 점을 감안하면 재정적자가 이자율을 변화시켜 환율에 영향을 주는 것은 기대하기 어렵다. 재정적자가 환율에 영향을 미치지 못하는 것으로 나타난 우리의 추정결과는 이러한 현실을 비교적 잘 반영하고 있다. 환율로부터 재정적자로의 장기적인 인과관계의 존재에 대해서는 명확한 설명이 쉽지 않다. 이러한 관계에 대한 하나의 가능한 설명은 두 변수가 수출, 소득 등의 다른 변수를 매개로 하여 장기적으로 함께 움직이는 경향이 존재 할 수 있다는 점이다.
전외측대퇴유리피판 (Anterolateral Thigh Free Flap)을 이용한 구강안면부 결손의 재건
김철환,방대연,황승연,Kim, Chul-Hwan,Bhang, Dae-Yeon,Hwang, Seung-Yeon 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.6
Recently, the anterolateral thigh(ALT) flap, based on the septocutaneous vessels or musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery has gained popularity in head and neck soft-tissue reconstruction. It has some advantages in free-flap surgery with respect to the radial forearm free flap, such as low donor site morbidity, availability of different tissues with large amounts of skin, adaptability as a sensate or flow-through flap (with the possibility of harvesting a long pedicle with a suitable vessel diameter). Moreover, the thickness of the flap is adjustable until the subdermal fat level, allowing it to be used as a thin or ultrathin flap. This clinical cases are ALT free flap reconstructions without functional impairment of the donor limbs (transitory and permanent) based on anastomosis with superficial temporal arteries and veins in patient of huge resection defect on face, lip and tongue.
환기현상의 수치적 해석을 위한 난류모델의 영향에 관한 연구
김철환(Chul Hwan Kim),유근종(Geun Jong Yoo),최훈기(Hoon Ki Choi),공영경(Yeong Kyung Kong),최유송(Yu Song Choi) 대한기계학회 2005 대한기계학회 춘추학술대회 Vol.2005 No.5
Ventilation is required to keep proper working condition inside building enclosure. Ventilation effect can be evaluated through numerical analysis before its implementation. Usual method of ventilation is mixed convection. Numerical analysis is performed with 3 different turbulence models of k-ε model, RNG k-ε model and Reynolds stress model. Also, 3 different wall functions are utilized in the analysis. Comparison of prediction results and experimental data show general agreement each other. The prediction performance with different turbulence models are shown similar each other.
생흡수성 폴리(PLLA-PGA) 메쉬 트레이와 자가입자망상골 및 늑골을 이용한 편측 하악골 결손의 재건
김철환(Chul Hwan Kim),김훈(Hoon Kim)정주은(Ju Eun Jung) 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.3
Loss of mandibular continuity can occur secondary to trauma, infection, or tumor resection. The basic goal of mandibular reconstruction is to restore bony continuity, arch form, osseous bulk, acceptable facial form. During the mandibular reconstruction is considered, surgical choices of using autogenous bone are divided into non-vascularized cortico-cancellous bone block graft, vascularized transfer of a cortico-cancellous bone block, and particulate marrow and cancellous bone(PMCB) graft. The PMCB has been successfully used for the reconstruction of mandibular osseous defect since introduced by Boyne, et al. This graft transplants a great density of osteocompetent cells, and promotes an early revascularization with vascular ingrowth with their particulate nature. However, because of their particulate nature, require tray or crib for containing PMCB. The Titanium mesh and Dacron-urethane trays have been used widely for this purpose, and allogenic mandible or rib, ilium have been also used. Recently, bioabsorbable polymer material is used to surgeon for treatment of craniofacial fracture and congenital anomaly of craniofacial skeleton in the form of plate, mesh and screw. In different natures to metal material, secondary operation is unnecessary due to biological degradation and resorption in the body with timing, and it can give adequate strength during the bone healing period. and it can be contoured easily during the operation. Especially, in pediatric applications, it can diminish the possibility of growth disturbance and back-scattering effects diminished when radiation therapy applied. Recently, the literature was reported for jaw reconstruction with PMCB and bioabsorbable polymer tray with animal study. In this case, 18-years old woman, who was diagnosed as ameloblastoma, was shown hemimandibular osseous defects. We performed secondary reconstruction using PMCB from posterior ilium, and rib bone with bioabsorbable poly(PLLA-PGA) mesh as a tray, and some favorable results were obtained and we report it preliminarily, with literature reviews.