아세틸 콜린 유발 검사시 허혈성 심전도 변화와 흉통의 발생이 내피세포 기능장애에 미치는 영향

최철웅(Cheol Ung Choi),나승운(Seung-Woon Rha),김선원(Sun Won Kim),나진오(Jin Oh Na),임홍의(Hong Euy Lim),김진원(Jin Won Kim),김응주(Eung Ju Kim),한성우(Seong Woo Han),박창규(Chang Gyu Park),서홍석(Hong Seog Seo),오동주(Dong Joo Oh) 대한임상노인의학회 2010 대한임상노인의학회지 Vol.11 No.4

연구배경: 아세틸 콜린 유발 검사시 발생하는 흉통과 허혈성 심전도 변화가 아세틸 콜린에 의해 발생하는 관상동맥의 내피세포 기능에 어떤 영향을 주는지 알아보고자 했다. 방법: 흉통으로 내원하여 관상동맥 조영술과 아세틸 콜린 유발검사를 시행받은 1,085명의 환자를 대상으로 하였다. 아세틸 콜린 유발 검사를 하는 동안 허혈성 심전도 변화 및 흉통의 발생 유무에 따른 관상동맥 내피세포 기능의 특징을 비교하였다. 결과: 539명의 환자에서 아세틸 콜린 검사시 내피세포 기능 장애가 발생 하였다. 허혈성 심전도 변화가 있었던 그룹이 심전도 변화가 없었던 그룹보다 흉통이 더 많았고(78.1% vs. 60.8%, P=0.007), 관상동맥 조영술상 다발성 관상동맥 경련이 빈번하였고(59.4% vs. 40.6%, P=0.004), 관상동맥의 경련 정도도 더 심하였다(64.1% vs. 46.5%, P=0.006). 흉통이 있었던 그룹이 흉통이 없었던 그룹보다 허혈성 심전도 변화의 빈도가 더 높았다(14.7% vs. 7.5%, P=0.007). 또한 흉통이 있었던 그룹이 관상동맥 경련이 다발성으로 발생하는 경우가 많았고 (50.7% vs. 29.5%, P<0.001), 미만성으로 발생하는 경우가 많았고(87.1% vs. 75%, P<0.001), 관상동맥의 경련의 정도도 더 심하였다(51.6% vs. 43.5%, P=0.041). 결론: 아세틸 콜린 유발검사시 발생하는 허혈성 심전도 변화와 흉통은 관상동맥 경련의 정도와 경련이 발생하는 관상동맥 개수와 연관이 있다. Background: ECG changes and chest pain during acetylcholine (Ach) provocation tests may constitute important clinical parameters for Ach-induced endothelial dysfunction. We investigated the association between ischemic ECG changes and chest pain during the Ach-provocation test and angiographic characteristics of Ach-induced endothelial dysfunction. Methods: A total of 1,085 patients with anginal symptoms underwent diagnostic coronary angiography (CAG) and Ach-provocation tests. We compared angiographic characteristics of Ach-induced endothelial dysfunction according to the presence of ECG change and chest pain. Results: A total of 539 patients experienced Ach-induced endothelial dysfunction. Patients who experienced ECG change group suffered more frequent chest pain (78.1% vs. 60.8%, P=0.007), angiographically more frequent multiple coronary artery spasm (59.4% vs. 40.6%, P=0.004), and more severe coronary artery spasm (64.1% vs. 46.5%, P=0.006) than patients without ECG change. However, there was no difference in the length of endothelial dysfunction between the groups. The incidence of ischemic ECG changes in patients with chest pain was higher than in patients without chest pain (14.7% vs. 7.5%, P=0.007). Patients who experienced chest pain more often experienced multiple (50.7% vs. 29.5%, P<0.001), diffuse (87.1% vs. 75%, P<0.001), and severe coronary artery spasm (51.6% vs. 43.5%, P=0.041) than patients without chest pain. Conclusion: Ischemic ECG changes and chest pain during the Ach-provocation test are associated with multi-vessel involvement and severe coronary artery spasm. Chest pain is associated with the length of endothelial dysfunction, but ischemic ECG change is not.

Rat의 복강내에 투여한 5-fluorouracil-polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

강대영,송규상,최정목,노승무,정경수,오정연,김진향,양준묵,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

For more effective intraperitoneal chemotherapy, the authers made 5-fluorouracil-polyglycolic acid composite disks(FU-PGA disks) with 5-fluorouracil and polyglycolic acid, a biodegradable polymer. We inserted the FU-PGA disk into the peritoneal cavites of Sprague-Dawley male rats, the control and three experimental groups; one FU-PGA disk insert group(300mg/kg), two FU-PGA disk insert group(600mg/kg), and three FU-PGA disk insert group(900mg/kg). The control group received a similar number of PGA disk inserts. A pharmacokinetic study was performed to measure the 5-fluorouracil concentration in the peritoneal fluid, blood, and tissues(liver, kidney and heart) at 24 hours, 72hours and 168 hours after insertion of the FU-PGA disk. Light and electron microscopic studies were done. The results were as follows: 1) The number of white blood cells and platelets decreased after FU-PGA insertion. The degree was proportional to the duration and amounts inserted. The change in the number of red blood cells varied slightly. 2) Light microscopically, slight changes were noted at 168 hours in the 3 disk insert group (900mg/kg). Mild fatty change and hepatocyte degeneration around the central veins of the liver were noted, with vacuolar degeneration in the proximal convoluted tubules of the kidney. 3) Electron microscopically,the liver showed focal increases of lipid droplets in the hepatocytes, and irregular nuclear membrane with focal nucleolar segregation of the fibrillar and granular elements. Also the double membranous structure of the hepatocytes and Kupffer cells was widened with bleb formation. The kidney showed wide separation of the nuclear double membrane in the proximal convoluted tubular cells and mesangial cells, with vacuolation and myelin figure formation in the mitochondria of the proximal convoluted tubular cells, at 72 hours and 168 hours in the 2 to 3 FU-PGA insert groups. The heart showed focal loss of cristae,vacuolation and myelin figure formation in the mitochondria of the 2 to 3 FU-PGA insert groups. In conclusion, despite the large amont of FU-PGA inserted, the histopathological changes in the liver, kidney and heart were slight, and consonant with the very low amount of 5-fluorouracil concentrations detected in the liver, kidney and heart. The above results suggest that the FU-PGA composite can serve as a new device for releasing drugs in a controlled manner and easily targeted to intraperitoneal organs. This device can improve the efficacy of intraperitoneal chemotherapy for gastric cancer.

Expression of cellular retinoic acid-binding protein-I (CRABP-I) in the cerebrospinal fluid of adult onset moyamoya disease and its association with clinical presentation and postoperative haemodynamic change

Jeon, Jin Sue,Ahn, Jun Hyong,Moon, Youn-joo,Cho, Won-Sang,Son, Young-Je,Kim, Seung-Ki,Wang, Kyu-Chang,Bang, Jae Seung,Kang, Hyun-Seung,Kim, Jeong Eun,Oh, Chang Wan BMJ Publishing Group Ltd 2014 Journal of neurology, neurosurgery and psychiatry Vol.85 No.7

<P><B>Objective</B></P><P>The elevation of cellular retinoic acid-binding protein-I (CRABP-I) has been suggested as a candidate in the pathogenesis of paediatric moyamoya disease (MMD). However, few studies have addressed CRABP-I in adult onset MMD. The aim of this study was to examine the expression of CRABP-I in the cerebrospinal fluid (CSF) of adult onset MMD, and to evaluate its association with clinical presentation and postoperative haemodynamic change.</P><P><B>Methods</B></P><P>This study examined the CSF from 103 patients: bilateral MMD, n=58 (56.3%); unilateral MMD, n=19 (18.4%); atherosclerotic cerebrovascular disease (ACVD), n=21 (20.4%); and control group, n=5 (4.9%). The intensity of CRABP-I was confirmed by western blotting and expressed as the median (25th–75th percentile). The differences in CRABP-I expression according to disease entity (unilateral MMD vs bilateral MMD vs ACVD), initial presenting symptoms (haemorrhage vs ischaemia) and postoperative haemodynamic change (vascular reserve in single photon emission CT and basal collateral vessels in digital subtraction angiography) were analysed.</P><P><B>Results</B></P><P>CRABP-I intensities in bilateral MMD (1.45(0.86–2.52)) were significantly higher than in unilateral MMD (0.91(0.78–1.20)) (p=0.044) or ACVD (0.85(0.66–1.11)) (p=0.004). No significant differences were noted based on the initial presenting symptoms (p=0.687). CRABP-I was not associated with improvement in vascular reserve (p=0.327), but with decrease in basal collateral vessels (p=0.023) postoperatively.</P><P><B>Conclusions</B></P><P>Higher CRABP-I in the CSF can be associated with typical bilateral MMD pathogenesis in adults. Additionally, postoperative basal collateral change may be related to the degree of CRABP-I expression.</P>

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Simplified Effective Compressive Strengths of Columns with Intervening Floor Slabs

Seung?Ho Choi,Jin?Ha Hwang,Sun?Jin Han,Hae?Chang Cho,Jae Hyun Kim,Kang Su Kim 한국콘크리트학회 2020 International Journal of Concrete Structures and M Vol.14 No.5

The current design codes discuss the effective compressive strengths of columns, which reflect a decrease in load transfer performance that can occur when columns and slabs have different concrete compressive strengths. The effective compressive strength of a column increases as it is confined by the slab, and the design codes mandate three different effective compressive strengths for interior columns (confinement on four sides), exterior columns (confinement on three sides), and corner columns (confinement on two sides). For both corner and exterior columns, the confinement effect of the slab is significantly smaller than that for the interior column, and there is a more marked decrease in load transfer performance. However, there is still a lack of theoretical studies investigating the effective compressive strengths of the corner and exterior columns. Therefore, based on the analysis model established in previous research, this study has proposed an equation for calculating the effective compressive strengths of the corner, exterior and isolated columns without any confinement effects of the slab. In addition, axial loading tests of isolated columns were conducted and the proposed equation was verified.

신규로 건설된 군 위댐 호내 어류 군집 및 생태적 특성에 관한 연구

이진웅 ( Jin Woong Lee ),윤주덕 ( Ju Duk Yoon ),김정희 ( Jeong Hui Kim ),박상현 ( Sang Hyeon Park ),백승호 ( Seung Ho Baek ),장광현 ( Kwang Hyeon Chang ),장민호 ( Min Ho Jang ) 한국하천호수학회(구 한국육수학회) 2015 생태와 환경 Vol.48 No.4

To secure water resources, dams are normally constructed on the upper - middle part of streams, and it generates physical disturbances such as habitat alteration and stream fragmentation. Such construction can restrict movement of aquatic organisms, especially for freshwater fish which is one of top predator in aquatic ecosystem, and cause genetic fragmentation and community change. In this study, to investigate impact of habitat alteration after dam construction on freshwater fish, we monitored fish community changes, and compared fish fauna between dam reservoir and inflows. Additionally, movement characteristics and habitat boundaries of four species were identified by radio telemetry method. The study was conducted in the Gunwi Dam which was constructed in December 2010. Radio telemetry was applied to Pungtungia herzi, Zacco platypus (living lotic and lentic), Silurus asotus (lentic preferred species) and Zacco koreanus (lotic preferred species). The number of species was remarkably decreased (4 family, 10 species) comparing with before the dam construction (7 family, 15 species). Specifically, Coreoleuciscus splendidus, Niwaella multifasciata, Liobagrus mediadiposalis, Coreoperca herzi and Odontobutis platycephala that inhabit in the lotic environment were not collected in the study area. A total of 8 species were caught in both the dam reservoir and tributaries except 2 species (C. auratus and S. asotus). Sorenson``s similarity between the reservoir and its tributaries was high (0.842). All of the radio tagged species stayed in the reservoir except S. asotus which moved to the tributary. These species mainly utilized the shallow littoral zone as a habitat. These results could be useful as a baseline data for efficient management of fishes in lakes.

흰쥐에서 반복적 스트레스가 GABA성 신경전달에 미치는 영향

김창수,이종범,성형모,시현석,김진성,박형배,정성덕,하정희 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

연구목적 : 일반적으로 생체는 각종 스트레스에 반응하여 적응(adaptation) 기전이 나타난다. 이러한 적응 기전과 관련하여 포유동물의 중요한 억제성 신경전달계인 GABA성 신경전달계의 스트레스성 자극에 대한 반응양상에 대한 연구가 진행되고 있다. 신경전달의 변화양상은 부하된 스트레스의 종류 및 기간에 따라 다양하게 나타나므로 더욱 상세한 연구를 필요로 한다. 방 법 : 본 연구에서는 하루 2시간의 부동화 스트레스를 반복적으로 2주간 부하한 흰쥐의 뇌조직에서 GABA성 신경전달의 변화 양상을 관찰하고자 하였다. 수용체 결합반응을 통하여 GABA 수용체의 각 component별 배위자들의 각 수용체에 대한 결합 반응의 변화 양상을 정상 대조군와 비교하여 보고, 유의한 변화가 있는 부분의 상세한 검정을 위하여 포화결합반응을 통하여 친화력(Kd) 및 최대결합력(Bmax)에서의 변화양상을 검색하였다. 뿐만 아니라 GABA성 신경전달에 관여하는 중요한 신경전달체인 내인성 GABA의 함량과 대사효소인 GABA transaminase의 활성도의 변화양상도 검색하였다. 결 과 : 연구결과 반복적인 부동화 스트레스는 GABA 수용체 효현제인 [³H]muscimol의 흰쥐 뇌조직 GABA 수용체에 대한 결합도에는 별다른 영향을 미치지 않았다. 대뇌피질조직의 GABA 대사효소인 GABA transaminase 활성도를 감소시켰으나, 피질조직외의 다른 조직의 GABA transaminase 활성도나 내인성 GABA의 농도에는 별다른 영향을 미치지 않았다. 반복적인 부동화 스트레스를 부하한 흰쥐의 대뇌피질, 해마 및 시상하부 조직에서는 [³H]flunitrazepam의 수용체 결합도가 감소하였으며, 포화결합 반응결과 수용체의 수가 감소하였음을 확인하였다. 결 론 : 이상의 결과를 요약하면, 흰쥐에게 부하한 반복적인 부동화 스트레스는 뇌조직의 benzodiazepine 수용체의 수를 감소시킴으로써 GABA성 신경전달을 감소시키며, 이러한 GABA성 신경전달계의 변환은 생체에서 스트레스로 인한 행동장애의 한 기전이 될 수 있을 것으로 생각되었다. Objectives : Changes of GABAergic neurotransmission in response to the application of different types of environmental stress have been the subject of research for over two decades. However, the nature of the changes induced by stress appear to show a dependent phenomena on the type and duration of stressor agent employed. Methods : For this reason, this study was performed to observe the effects of repeated stress on the radioligands binding to GABAA/benzodiazepine receptors of discrete brain regions. The author also examined the activity of GABA transaminase and the concentration of endogenous GABA. Male Sprague-Dawley rats, weighing 150-200g were forced to suffer an immobilization stress for 2 hours during 14 consecutive days. Results : Repeated immobilization stress decreased the binding of [3H]flunitrazepam on the benzodiazepine receptor in the cortex, hippocampus and hypothalamus. Saturation experiments followed by scatchard analyses of the results showed decreased density of benzodiazepine receptor and the affinity remained unchanged. Repeated immobilization stress did not affect the binding of [3H]muscimol on the GABAA receptor, the activity of GABA transaminase, and the concentration of endogenous GABA in the brain regions. Conclusions : From these results, it can be concluded that repeated immobilization stress modulated GABAergic neurotransmission via downregulation of the benzodiazepine receptor in the brain.

흰쥐에 對한 Phosphamidon 및 Endosulfan의 亞急性毒性에 關한 硏究

申鎭燮,崔承允,李昌業,崔仁厚 서울大學校 農科大學 1984 서울대농학연구지 Vol.9 No.2

Subacute toxicity tests of phosphamidon and endosulfan were carried out to examine the adverse effects resulting from repeated daily oral administration of low dose levels (1, 2 and 5 mg/kg/day) to rats for 28 days. The results were summarized as follows: 1. Rats showed clinical signs of salivation hyperactivity, ataxia at 2mg/kg/day dosage of phosphamidon and, in addition, lachrymation, tremor, exophthalmus and diarrhea at the highest level. On the other hand, endosulfan caused only hyperactivity in rats treated with the highest dosage. There was no mortality at any dosage of either pesticide. 2. Rats gained significantly lower body weight, when treated at the 5mg/kg/day dose levels of phosphamidon and endosulfan, in comparison to normal, nontreated rats. 3. Plasma cholinesterase activity was significantly depressed at all levels of phosphamidon during the administration period, but returned to normal within 2 weeks after the last administration. Endosulfan did not change plasma cholinesterase activity at any levels. 4. Leukopenia was detected only in rats treated with phosphamidon at 5mg/kg/day level. No other adverse changes in hematology were observed in rats treated either with phosphamidon at lower levels or with endosulfan at any levels. 5. Cloudy swelling of liver was the only histological change in rats treated with phosphamidon or endosulfan at the highest level. No other histopathological change in rats treated with phosphamidon or endosulfan at the highest level. No other histopathological symptoms were found in spleen, heart, kidney, and bone marrow of rats treated. 6. It may be concluded from the results above that the "no effect level" is 1 mg/kg/day and 2 mg/kg/day for phosphamidon and endosulfan, respectively.

첨가제를 첨가한 TMA-포접화합물의 상변화에 관한 실험적 연구

김진흥,정낙규,김창오,박호진,강승현,김광일 朝鮮大學校 機械技術硏究所 2002 機械技術硏究 Vol.5 No.2

The purpose of this study is to investigate the propriety of TMA clathrate as a cold storage medium. Particularly, this is to examine the extent of subcooling improvement when the surfactants are added to the TMA clathrate, because water used cold storage material has low phase change temperature and subcooling. this study has been analysed and compared with TMA 30wt% clathrate how phase change temperature, subcooling and specific heat in the various concentrations are changed. This results view to be improved phase change temperature and subcooling of TMA30wt% as a cold storage medium, when it had some surfactant. Additionally, it is that surfactant must be controlled under available solution limit and study for new additive must be lasted to know its effect.

Open reduction and internal fixation of condylar fracture through intraoral approach-technique and clinical results

김재승(Jae Seung, Kim),장현호(Hyun Ho Chang),김만진(Man Jin Kim),한승윤(Seung Yun Han) 대한구강악안면외과학회 1995 대한구강악안면외과학회지 Vol.21 No.4

하악과두골절에 대한 처치방법은 수십년 전부터 연구되어지고 발전되어오고 있지만 아직 논란의 여지가 많은 것이 사실이다. 현재까지 쓰이고 있는 방법은 크게 두가지로 대별되는데, 첫째는 수술없이 하악골의 운동을 통해 정상적인 기능을 찾아주고자 하는 보존적인 방법이 되겠고 두번째는 수술, 즉 구강의 접근법을 통한 정복 고정술이 되는데 진이개 접근법이나 Risdon 접근법을 통한 직접 정복 고정술, 남씨 방법, 또 최근의 Lag screw를 이용한 방법 등이 여기에 속한다. 성장기 아동이나 골절부위가 capsule 내부 등 과두부의 상부에 위치하여 오히려 수술 후 합병증이 예상되는 경우에는 보존적인 방법을 택하나, 성인의 경우에서는 특히 원래의 해부학적 형태를 회복하지 못하는 데서 오는 과두부 운동 제한 및 하악골 운동 상태의 변회 등을 볼 수 있다. 따라서 골절선이 과두경부 및 그 하방인 경우 많은 외과의사들은 아직 관혈적 정복 고정술로 하악골을 원래의 해부학적 형태로 회복시키고자 한다. 하지만 접근경로에 따른 외부반흔, 안면 신경 손상, 과도한 골막 박리 등에 의한 골절편 흡수 및 괴사 등이 문제로 되고 있다. 따라서 저자 등은 구강내 접근법을 통하여 보존적 방법과 구강외 접근법에 의한 수술의 단점을 보완하면서 골절 부위를 원래의 해부학적 형태로 복원하고자 하였다. 이에 본 논문에서는 구강내 접근법원을 통한 하악과두 정복 고정술의 방법 및 임상적 결과를 소개하고자 한다. 본 연구는 1993년 5울 부터 1995년 2원 까지 경험한 19명의 과두부 골절 호나자 중 구강내 접근법으로 수술하고 3개월에서 1년 까지 관찰한 5명을 대상으로 하였다. 연구 결과는 다음과 같다. 1. 구강내 접근법은 구강외 접근법에 비해 안변 산경 손상, 반흔, 골조직 괴사 등의 기능성을 없앨 수 있었다. 2. 구장내 접근법을 통하여 수술한 환자 5명 모두에서 안정된 교합과 함께 개구 및 전, 측방운동을 포함한 하악골 운동 장애는 없었으며 개구 및 전방 운동시 편측으로의 변위도 관찰되지 않았다. 3. 구강내 접근법은 경우에 따라 골절선의 시야 확보가 어려울 수 있으므로 골절선이 과두경부 하방으로 위치할 때 시행하는 것이 좋겠다. The methods of management ofr condylar fractures have been investigated and improved for several decades. The methods which have been used up to date are classified broadly into conservative and surgical treatment. Conservative treatment is planned to restore normal function through intermaxillary fixation and early exercises of mandibular movement. It is chosen in the cases of children s or growing adolescent s fractures and adult s intracapsular or high condylar fracture. Although long term results proved conservative treatment to be satisfactory, it is impossible to restore the preexisting anatomic relation and it may cause dysfunction or limitation of mandibular movement. So surgical intervention has been advocated for various types of condylar fracture. Until now, most surgical treatments have been undertaken by the following methods such as preauricular or Risdon approach, Nam s method, and lag screw fixation method. All of them are through an extraoral approach, which can cause complications such as facial nerve injury, external scar, and resorption or necrosis of bone fragments. In order to overcome these complications, we attempted an intraoral approach. In this article, the technique and the clinical results of an intraoral approach are presented. We treated 5 patients having subcondylar (4) and low condylar neck (1) fractures with the use of an intraoral approach from May, 1993 to February, 1995. After 3 to 12 months follow-up, we could draw the following conclusions. 1. An intraoral approach has advantages over an extraoral approach ; No facial nerve damage, no facial scar, and the decrease of possibility of necrotic bone change. 2. The 5 patients treated in this technique had a stable occlusion state and all of them had no functional disturbance such as limitation of opening, protrusive and laterotrusive movements. Protrusive and opening deviation was not also noted. 3. Because the intraoral approach has some limitation in gaining enough visibility, it is better to use this method in cases of which fracture line is present below the condylar neck.