치아 마모 환자에서 수직고경 증가를 동반하여 단일구조 지르코니아 보철물로 완전구강회복을 시행한 증례

오경철,정문규,김지환,심준성 大韓齒科補綴學會 2012 대한치과보철학회지 Vol.50 No.3

과도한 치아 마모는 교합면에 손상을 야기하고, 치수 병변, 교합 부조화, 기능장애, 심미적 문제 등을 야기할 수 있다. 과도한 치아 마모를 갖고 있는 환자들을 치료하고자 할 때 수직교합고경(vertical dimension of occlusion, VDO)의 상실 여부와 수복을 위한 악간 공간의 적절성 여부에 기반하여 분류를 할 필요가 있다. 본 증례의 환자는 다수 치아들의 마모를 지닌 50세의 남성으로, 과도한 치아 마모가 있지만 수직교합고경의 상실은 없으며 수복을 위한 악간 공간이 부족하였다. 이러한 경우 수직교합고경을 증가시켜 치료를 진행하는 것을 고려할 수 있다. 수직교합고경의 증가를 필요한 범위 내에서 최소로 줄이고, 증가된 수직교합고경 상에서 안정화 기간을 거친 뒤 안정된 교합 접촉을 제공할 수 있다면, 수직고경 증가를 동반한 치료법은 안정성을 가질 수 있다. 본 남성 환자를 치료하기 위해 수직고경의 증가를 동반하여 전치부와 구치부에서 단일 구조 지르코니아를 이용한 고정성 보철물로 수복을 하였다. 일련의 치료과정을 통하여 기능적인 면과 심미적인 면에서 만족스러운 결과를 얻었기에 보고하는 바이다. Excessive occlusal wear results in unacceptable damage to the occluding surfaces, and can cause pulpal injury, occlusal disharmony, impaired function, and aesthetic deformity. Patients with severely worn dentition need to be classified as several categories relative to the vertical dimension of occlusion (VDO) and the interocclusal distance for the prosthetic space. When treating patients classified as those who have excessive wear without loss of occlusal vertical dimension but with limited space, we could consider treating them at an increased vertical dimension of occlusion. Treatments at an increased vertical dimension of occlusion may provide stability, given that the amount of its increase was minimal, and a perfected occlusion was achieved after enough stabilization period. A 50-year-old male visited the department of Prosthodontics in Yonsei University Dental Hospital with the chief complaint of worn teeth on lower anterior area. Reconstruction at an increased vertical dimension of occlusion was planned. After the compatibility of the new vertical dimension of occlusion had been confirmed under interim fixed restorations, definitive fixed restorations composed of full-contour monolithic zirconia prostheses were placed. This case presents that a satisfactory clinical result was achieved by restoring the worn dentition at an increased vertical dimension of occlusion with an improvement in esthetics and function.

회전근 개 파열 관절중에서 시행한 역구형 관절 치환술 : 2례 보고

문영래,이상홍,노경환 朝鮮大學校 附設 醫學硏究所 2009 The Medical Journal of Chosun University Vol.34 No.1

결별의 시대에서 조화의 시대로 : (Ⅰ) 19세기의 경우 Ⅰ: What Happened in the 19th Century?

문경환 연세대학교 인문과학연구소 1996 人文科學 Vol.75 No.-

The academia of the past two centuries or so has undergone a crescendo of ramification and compartmentalization, in which 'specialism' is the name of the game. This process has made it possible for the 'specialist', safely enclosed within the limits of his visual field, to succeed in unearthing important facts and concepts that have hitherto been unthought of. These new findings have in turn pulled off redoubtable achievements in science and technology, which bespeak of the possibility of virtually limitless progress in these areas. On the other hand, however, the specialist, throught having to constrain the sphere of his interest and investigation, has been progressively losing contact with other branches of learning. The end­product is a curious type of man who is well informed in his own tiny portion of the universe but professedly and blithely ignorant of all that does not enter into his specialty­­who is, in Ortega y Gasset´s terms, ´learned ignoramus.´ Worse still, this new type of man is perfectly ready to wield his flimsy yardstick with pomp and circumstance, scaling other people´s intellectual concerns and capacities, and turning a deaf ear to what does not seem to tally with his own sciolistic knowledge or belief. At last, on the verge on the century´s curtain time, we are awaking to the grave impacts of specialism with growing apprehensions. Attesting to this is the catchword ´interdisciplinary,´ which is now on the tongues of all but everyone working in the academic circles. No wonder the craze for ´departmental consolidation´ is sweeping over our universities with hurricane force. But what exactly is this ´no­department´ business supposed to mean? Are we now to undo and reverse the whole process of specialization that has so far seemed so beneficial to our intellectual activities? How, in other words, can we deal with the schizophrenia of ´learned ignorance,´ while still taking full advantage of specialism? The term ´inter­disciplinary´ does not carry much force here, since, to my mind, the notion of ´discipline´ itself has become only too nebulous in our educational system. Neither does the now fashionable idea if ´graduate­school­centered university.´ Rendered back into Korean, the original language that accounts for this very terminology, it simply turns out to be a case of oxymoron. To be sure, etiology is a prerequisite for treatment. Before we can imagine how the different academic research areas can be reconciled to a workable degree, we need to know how they have come to a rupture in the first place. Otherwise, the glossy jargon words just cited will prove to be more a matter on empty slogans than anything else, serving a verbal banquet at best. With this as its guiding motif, the present paper makes a brief survey of the main currents of thought and the concomitant social conditions that characterize the 19th century. The discussion centers around the rise of scientism, evolutionism, psychologism, and historicism, looking as well into the run of event ensuing on them. This trend of thought, it is claimed, has contributed to the process of specialization that has continued well into the 20th century. This in fact constitutes only a half of the story that I intend to present under the captioned topic: the space available here does not permit us to span the length of two centuries at one time. In the sequel, which will appear in the following issue, we will go into the status quo of the 20th century, largely focusing on the scholarly atmosphere that accelerated the process of specialization, and the more recent movement toward a new outlook on scholarship, which is on foot as a reaction against the excessiveness of the process in question.

치과진료실에서 황색 포도구균의 감염유형 분석

문상은,이동근,권경환,김강주 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.1

To investigate the cross contamination in the dental clinic, Staphylococcus aureus, the pathogen in acute pyogenic infection and one of the important microbes causing nosocomial infection, was isolated from the mouth and anterior nare of healthy personnel and patients and the air in the dental clinic. The patterns of antibiotic susceptibility of the isolated staphylococci were examined. mecA gene from the MRSA was detected by polymerase chain reaction (PCR). The isolation rate of S. aureus in the dental clinic was the highest in the mouth of dentists (29.4%) and the lowest in the air of the dental clinic (1.3%). In the study of PCR, MRSA and some methicillin susceptible staphylococci had mecA positive gene. These results suggest that staphylococci in the dental environment might be one of the important causes of nosocomial infection in the dental clinic.

휴머니즘 : 그 빛과 그림자 Its Light and Its Shade

문경환 연세대학교 인문과학연구소 1995 人文科學 Vol.73 No.-

Everything under the sun has its bright side and dark sid, because it is under the sun. Humanism in the sun is the hues of a rainbow; humanism in the shade is the haze of the limbo. Humanism in its true sense is humility with dignity; humanism in disguise is humiliating indignity. Humanism in the highest is the halo of honor; humanism in the lowest is a hell of a howler. Humanism in a word, is a dilemmatic milestone. It can lead to the mountain peaks of hope and glory or to the bottomless pit of vainglory. Maybe it´s all because of the ´ism´tacked on to its name. For, free of this troublesome appendix, "every human heart is human," as goes a line of a poem I don´t remember whose. But think twice before you damn this poor little word. For every human ism is human also. An ism after all is a human endeavor, in the hope of better understanding human morality, human mortality, human capacities, human infirmities--in short, things human. This paper invites you to the crossroads of humanism, showing you around to its sunny greens of lush pastures and to its gloomy dells of lurking vultures. During your journey you will be ushered once in a while to a resting place so you can stop and think about what the branch of learning called the humanities should be like. At the end of your trip, you will find yourself having made a quick tour, as well, of the historical development of humanism and humanistic scholarship.

한국 정상인에서 연령에 따른 뇌혈류분포와 혈류예비능의 변화 : Tc-99m HMPAO SPECT 에 의한 연구

문대혁,이희경,송호천,이재태,범희승,손혜경,정환정,민정준,김지열 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.3

Purpose: The aim of this study was to evaluate the normal values of regional cerebral blood flow (rCBF) and cerebrovascular reserve (CVR) in normal children to aged volunteers using Tc-99m HMPAO. Materials and Methods: Thirty four right-handed normal volunteers (20 males, 14 females, mean age 40.3±24.9 years, range 4 to 82 years) were underwent rest/acetazolamide (ACZ) brain SPECT using Tc-99m HMPAO and the sequential injection and subtraction method. rCBF was estimated on the basis of a semiquantitative approach by means of right/left ratio, region/cerebellum and region to whole brain ratios in frontal, parietal, temporal, and occipital lobes, basal ganglia, thalami, and cerebellum. CVR was measured by means of % perfusion increase calculated as % mean count change compared to rest rCBF in each regions. Results: Mean values of right to left ratios range from 1.004 to 1.018. rCBF was highest in cerebellum and lowest in basal ganglia and thalami. Frontal and temporal rCBF decreased while occipital and thalami rCBF increased according to age. No sexual difference of rCBF was noted. Mean CVR was 29.9±12.9%. Mean CVR significantly increased to late teens, and declined thereafter. After 6th decade, CVR in both frontal lobes, left parietal lobe and right basal ganglia decreased significantly with advancing age. There was no sexual difference of CVR. Conclusion: Quantitative assessment of CVR was possible by ACZ Tc-99m HMPAO brain SPECT. It revealed that rCBF and CVR changed according to age in normal Korean volunteers. There was no sexual difference.

환자이탈군 특성요인과 이탈환자 예측모형에 관한 연구

민경진,송규문,김광환 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.1

Background : We developed a model for predicting premature discharge and identifying related factors. Methods : Prediction model was developed by data mining techniques. Basic data were collected from the total discharge data base of a university hospitals in Chungnam province during the period from July 1, 1999 to June 30, 2000. Results : 1. Among 22,873 patients, the number of patients discharge with usual discharge orders were 21,695 or 94.8%. The number of the prematurely discharged patients were 1,178 or 5.2%. 2. The primary reason for unusal discharge was transfer to other hospital. Move to a local hospital closer to their home and burdensome medical expenses were main reasons. 3. Predictability of each model was tested using the top 10 percent of patients with the highest probabilities of premature discharge. The neural network model was chosen as the most appropriate model for predicting prematurely discharged patients. 4. Ten percent of the total number of patients had been selected randomly to test the effectiveness of the neural network model. We have chosen the threshold of the neural network model as 0.7. The number of patients who were expected to discharge prematurely was 312. Among them, 241 had been discharged prematurely(77.2%). Conclusion : of the several data mining techniques used, the neural network model was the most effective, It can be used to identify and manage the patients who are expected to discharge prematurely.

안면신경초종 1례

고의경,이지원,문영일,노환중 釜算慶南耳鼻咽喉科學會 1996 임상이비인후과 Vol.7 No.2

접착제와 와동형성의 차이에 따른 5급 복합레진 수복의 전향적 임상연구

이경욱,정세준,한영철,손호현,엄정문,오명환,조병훈 大韓齒科保存學會 2006 Restorative Dentistry & Endodontics Vol.31 No.4

본 연구의 목적은 복합레진을 이용한 비우식성 치경부 5급 병소 수복에 있어서, 3가지 다른 접착제를, 유지구를 부여한 치아와 부여하지 않은 치아에 적용하였을 때의 임상적인 효능의 차이를 비교하기 위함이다. 총 150개의 치아를 각각 25개씩 6개의 군으로 나누었다. A군 Scotchbond Multi-Purpose (SBMP, 3M ESPE, St, Paul, MN, USA, 4세대 접착제)를 사용하고 유지구를 부여하지 않음. B군: SBMP를 사용하고 유지구를 부여. C군: BC Plus (Vericom Co., Anyang, Gyeonggido, Korea, 5세대 접착제)를 사용하고 유지구를 부여하지 않음. D군: BC Plus를 사용하고 유지구를 부여. E군: Adper Prompt (3M ESPE, Seefeld, Germany, 6세대 접착제)를 사용하고 유지구를 부여하지 않음. F군: Adper Prompt를 사용하고 유지구를 부여. 모든 치아는 복합레진인 Denfil(Vericom Co., Anyang. Gyonggido. Korea)을 이용하여 충전하였다. 수복 직후와, 수복 6개월 후에 modified USPHS (United States Public Health Service) criteria에 따라 수복물을 임상적으로 평가하였다. 추가적으로 임상사진을 촬영하였으며, 에폭시 레진을 이용하여 복제한 후 주사전자현미경을 이용하여 이를 관찰하였다. 6개월 후 관찰 결과. alpha rating의 수가 각 실험군마다 동일하지는 않았지만, 통계적으로는 3가지의 접착제간에 유의할만한 차이는 없었고, 기계적인 유지구를 부여한 군과 부여하지 않은 군 간에도 유의할만한 차이는 없었다 (p > 0.05). 그러나 6개월의 관찰 기간은 일반적으로 기대되는 레진의 수명보다 짧기 때문에, 각 실험군 간의 차이를 알아보기 위해서는 추후 더 오랜 기간의 관찰이 요구된다. The purpose of this study is to evaluate prospectively the effect of different bonding systems and retention grooves on the clinical performance of resin restorations in non-carious cervical lesions (NCCLs). Thirty nine healthy adults who had at least 2 NCCLs in their promolar areas were included in this study. One hundred and fifty teeth were equally assigned to six groups; (A) Scotchbond Multi-Purpose (SBMP, 3M ESPE, St, Paul, MN, USA, 4th generation bonding system) without retention grooves; (B) SBMP with retention grooves: (C) BC Plus (Vericom Co., Anyang, Gyeonggido, Korea, 5th generation bonding system) without retention grooves; (D) BC Plus with retention grooves; (E) Adper Prompt (3M ESPE, Seefeld, Germany, 6th generation bonding system) without retention grooves: (F) Adper Prompt with retention grooves. All cavities were filled with a hybrid composite resin, Denfil (Vericom Co., Anyang, Gyeonggido, korea) by one operator. Restorations were evaluated at baseline and at 6-month recall, according to the modified USPHS (United states Public Health Service) criteria, Additionally, clinical photographs were taken and epoxy resin replicas were made for SEM evaluation. At 6-month recall, there were some differences in the number of alpha ratings among the experimental groups. But, despite the differences in the number of alpah ratings, there was no significant difference among the 3 adhesive systems (p > 0.05). There was also no significant difference between the groups with or without mechanical retention (p > 0.05). Follow-ups for longer periods than 6 months are needed to verify the clinical performance of different bonding systems and retention grooves. 〔J Kor Acad Cons Dent 31(4):300-311, 2006〕

척추관 협찬증 환자 진료 프로세스 개발

이환모,김호중,김긍년,안풍기,천자혜,김양수,신혜선,김인숙,정혜경,김영아,채형기,박인영 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.2

연구배경: 수술적 치료가 필요한 척추관협착증 환자들은 주로 60세 이상의 고령환자로장기간의 입원 시 기회 감염의 증대와 불필요한 의료비의 증대를 가져오게 되며, 수술후환χ}들의 재원일수의 증가는병원의 병상가 동률을감소시키고, 전공의에게는불필요한 업무를 증가시킨다. 연구목적: 비용·효과면에서 최적화된 진료지침의 개발은 불필요한 의료비의 감소및 Hospital Induced Complication을 줄여 환자만족도를증진시킬 수 있으며, 각 환자에 대한전공의 업무를 줄일 수있다. 의료기관: 서울특별시에 소재한 2,075병상의 종합전문 요양기관 연구방법: 정형외과및 신경외과의 척추관협착증환자 의 처방을 비교하여 최적의 표준진료지침을 개발하고 최종적으로 CP Master Program (EMR 프로그램)에 입력하여 환자에게 적용하였다. 연구결과': CP 적용전, 후비교를통해 재원일수는 3.8일 이 감소하였으며, 이에 따라 병상가동률 및 진료수익이 증가했으리라고 예상되며 현재 비교검토중이다. 또한,CP 개발및 CP Master Program의 사용을 통한 전공의 업무감소에 대해 검토하고 있다.