고관절 전치환술시 응용프로그램을 이용한 수술 전 계획

원중희,김용민,최의성,손현철,박경진,남기세,정재중 대한고관절학회 2003 Hip and Pelvis Vol.15 No.3

대퇴골두 무혈성 괴사의 자기공명 영상과 조직검사와의 비교 연구

원중희,장봉순 충북대학교 의과대학 충북대학교 의학연구소 1994 忠北醫大學術誌 Vol.4 No.2

대퇴골두 무혈성괴사의 자기공명영상 소견을 조직병리학 소견과 비교연구하였다. 11명의 환자 12회의 고관절에 관해 연구하였다. 3례의 고관절은 Stage 2, 6례는 Stage 3, 3례는 Stage 4였다(Ficat and Alert). 표본은 영상에 따라 절개하여 조직학적으로 연구하고 T1, T2 자기공명영상과 연관지었다. 초기에 괴사 소견은 T1에서 음영이 증가되었다. 괴사골과 괴사지방이 괴사부분에서의 낮은 음영을 나타내었다. 괴사부위 주위의 낮은 음영의 띠는 섬유조직과 골반응을 나타내는 것이다. 괴사부 밖의 음영도 정상지방골수에 비하면 감소되었다. 자기공명영상 소견은 각각의 진행시기나 대퇴골두에 따라 차이가 있었으나 조직학적 소견과 상호연관지을 수 있었다. Magnetic resonance image of INFH were correlated with histopathologic sections. Eleven patients with twelve hips were included in this study. Preoperative radiographs and MRI were taken for the patients. Three hips were in stage Ⅱ, six hips were in stage Ⅲ, and remaining three were in stage Ⅳ respectively(Ficat and Alert). These hips were replaced with artificial joint and resected heads were examined. The specimens were bisected along the imaging plane, and studied histologically and matched with respective MR images of T1 and T2. Necrotic portion in earlier stage showed higher signal intensity in T1-weighted image. Subchondral void, necrotic bone, and saponified fat were responsible for low signal intensity in necrotic portion. Low signal band adjacent to the necrotic foci represented inner fibrous tissue and outer reactive sclerotic bone. Outside the necrotic foci, the signal intensity diminished compared with normal fatty marrow. These findings were attributed by cellular infiltration and trabecular bony proliferation. MRI patterns were variable in various stages and each femoral head, but corresponded well with histologic findings.

무증상 대퇴골두 무혈성 괴사의 증상발현

원중희,김용민,최의성,이호승,서중배,배병권 대한고관절학회 2001 Hip and Pelvis Vol.13 No.1

仁川敎育大學 自體評價를 위한 기초연구

金忠幸,文仁元,崔熙善 仁川敎育大學校 1991 論文集 Vol.25 No.2

This Study was intended to present a fundamental materials for the self-evaluation of the Inchon Teachers College. Among the six areas which were divided by the Korean Counil for University Education (KCUE), this study tried to analyze the educational goal and objectives the curriculum, and the administration and finance of the college. The results of the study are the followings; 1. The goal and objectives a. It can be said that pursuit for realizing the general ideal, and the public relation for the goal belong to the low level. b. The goal and objectives are made by no consent of the whole members, and by no proper procedures. c. There is a tendency of no systematic relationship betweeh the goal and the objectives of the College. 2. The curriculum a. The curriculum of the College can be evaluated that it fairly well reflects the goal and objectives of the College, but the total credits, especially the credits of general course, are heavier than those of other teacher training institutes. b. according to the survey of the student they want the faculties (1) to prepare for the content of the lectures more intensively, (2) to lecture the content in accordence with the objectives of the instruction (3) and they also indicated that the questions and the discussions are not active during the lectures. c. The sequence of the intensive courese can be maintained, but there are some intensive courses where the characteristics of the elementary teacher training institute have not been considered. The administration and the finance a.No functional connection between the line and the staff organization seems to exist. b. The planning for the College development can be recognized, but the efficiency of its implementation seems to be low. c. The budget of the College seems to be managed unilaterally, and the criteria of the budget allocation are not clear.

고관절 전치환술에서 하지 길이의 변화 : 수술전 예상 측정치와 수술후 실제 측정치 사이의 차이에 대하여 Differences between preoperative prediction and postoperative measurement

강희중,원중희 충북대학교 의과대학 충북대학교 의학연구소 1994 忠北醫大學術誌 Vol.4 No.2

하지 길이의 적절한 회복은 고관절 전치환술의 목적중 하나다. 수술후 하지 길이의 변화를 수술전 예측 평가한 것이 수술후 실제로 측정한 것과 항상 일치하지는 않는다. 이에 저자들은 골시멘트를 사용하지 않고 수술한 고관절 전치환술 40예에서, 수술전 예측한 하지 길이 변화와 수술후 측정한 하지 길이의 차이에 대해, 이들 차이에 영향을 주는 요인을 조사하였다. 위 예들중에서 치료하지 않은 선천성 고관절 탈구증과 같이 수술전 하지 길이의 차이가 많은 경우는 제외하였다. 대퇴부에 사용한 인공삽입물은 Omnifit(Ostenonics) 혹은 CLS(Protek) 스템이었고 비구컵은 모두 Harris-Galante Ⅱ(Zimmer)였다. 수술전 비구 가늡자(template)를 방사선 사진 위에 놓고 비구컵 중심을 연필로 그린 후, 대퇴 스템 가늡자(template)를 대퇴부에 놓고 대퇴 골두 중심을 그린다음, 위 중심의 거리 차이를 수술전 하지길이 변화의 예측치로 하고, 수술후에는 골반의 눈물방울선(inter-teardrop line)에서 대전자부 끝을 이은 선의 거리를 수술전과 비교하여 하지 길이 변화로 하였다. 수술전 측정한 하지 길이 변화 예측치는 평균 9㎜였고, 수술후 측정한 하지 길이 변화 측정치는 평균 14㎜였다. 이와같은 수술전 예측치와 수술후 하지 길이 측정치의 차이는 여러가지 요인에 의해 영향을 받을 수 있겠다. 우선 방사선 사진의 측정방법이 중요한 요인이다. 확대정도나 방사선조사선의 중심, 그리고 고관절의 정확한 위치 등이 수술전 방사선 촬영에서 고려되어야 할 것이다. 가늡자(template)를 사용하는 기술은 또 다른 중요한 요인이다. 수술전 측정과 비교하여 보면 수술후 비구 중심이 이동하는 경우가 있었다. 수술전 측정과 실제 삽입한 대퇴 스템의 크기가 일치하지 않은 경우가 있는데 이로 인해 하지 길이의 변화가 유발될 수 있다. 수술전 예측한 하지 길이의 변화가 항상 수술후 하지 길이의 변화와 일치하지는 않는다. 따라서 수술전 측정한 것과 수술후의 하지 길이 변화의 차이를 최소화 하려면, 위의 요인들을 수술전 측정에서 충분히 고려하여야 할 것이다. One of the aims of THA is to restore the appropriate leg length. Preoperative estimation of postoperative leg length change does not always result in predicted value when measured postoperatively. We reviewed 40 cases of cementless THA to see the leg length changes after THA and analysed the factors that could affect the discrepancies of preoperative estimation and postoperative measurement. The cases with severe preoperative leg length discrepancy such as untreated CDH were not included in our series. Inserted femoral were Omnifit(Osteonics) or CLS(Protek) stems. All the acetabular cups were HG Ⅱ(Zimmer) cups. Preoperatively the acetabular template was mounted on the film and the center of the acetabular cup was marked with pencil. Femoral template was also mounted on the femoral side and the center of the femoral head was marked. The distance between the two centers was a basis for preoperative estimation. Postoperatively the leg length change was measured by the change of the distance from inter-teardrop line to the greater trochanter tip. Leg length change estimated by preoperative templating was 9㎜ lengthening in average. Postoperative leg length change was 14㎜ lengthening in average. The discrepancies of pre and postoperativen measurement were attributed to following factors. Standardization of taking the X-ray views was an important factor. Magnification, center of X-ray beam and the accurate position of the hip should be considered in taking preoperative X-rays. Templating technique was another factor. Postoperative acetabular center shifted frequently compared with preoperative estimation. The size of the stem was not always matched with preoperative templating, and this resulted in different leg length changes. Templating does not always tell accurate postoperative leg length change. To minimize the discrepancy of pre and postoperative measurement above factors should be considered in peroperative estimation.

구개부에 발생한 다형선종의 처치

하주원,백승,송종운,박충열,이용욱,박홍주,오희균,유선열,김옥준 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

Pleomorphic adenoma of the palate is the most common of all intraoral salivary tumors. It can occur at any age but it presents most commonly in the 40∼60 age group, and there is no significant sex preponderance. It grows slowly and is usually painless, firm, well-circumscribed nodule. Because of high rate of recurrence, extra-capsular excision including the overlying mucosa and margin of normal tissue is recommended. We report 10 cases of palatal pelomorphic adenoma which have been successfully treated by extra-capsular excision. The surgical defects smaller than 3㎝ in diameter were covered with palatal acrylic splint for the secondary healing. The larger defects were repaired using palatal island flap in 3 cases, rotation flap and buccal fat graft in each 1 case. No patient showed any recurrence or malignant change during the mean follow-up period of 4 years and 9 months. These repair methods seem to be simple, reliable and uncomplicated procedures in the palatal surgical defects.

정신분열병 입원 환자에서 단축형 증상관리 훈련의 효과:예비적 연구

최충식,채정호,우동원,최영희,함웅,이규항,장미화 대한신경정신의학회 2001 신경정신의학 Vol.40 No.1

연구목적: 정신분열병 환자에서의 재활치료는 개인의 극복 기술과 능력을 향상시키고 재발을 유발시킬 수 있는 스트레스의 부정적인 영향을 중화시킴으로써 질병의 만성화를 막고 사회기능을 호전시킬 수 있기에 점차 그 중요성이 대두되고 있다. 본 연구는 만성 정신분열병 입원 환자에서 재활치료의 하나인 단축형 증상관리 훈련이 정신장애에 대한 자기 인식에 미치는 효능을 알아보기 위하여 시행되었다. 방법: 정신분열병으로 진단받고 입원 중인 환자들에게 재발경고징후를 규명하는 것, 재발경고징후를 관리하는 것, 지속증상을 극복하는 것, 술과 불법 약물을 피하는 것 등으로 구성된 승인-UCLA 사회기술 및 독립적인 생활기술훈련 단위 중 증상관리단위를 기초로 한국실정에 맞게 축약한 증산관리 훈련을 주 1회, 60분씩, 4∼5주간 실시하였고 실시 전후에 전신장애 비인식 평가 척도(Scale to Assess Unawareness ofMental Disorder; 이하 SUMD)로 자신의 정신장애에 대한 인식을 평가하였으며 임상적 전반적 인상(Clinical Global Impression;이하 CGI)로 임상 상태를 조사하였고 각 인구학적 변인들을 조사하였다. 결과: 환자 30명이 훈련을 완수하였으며 이들의 평균 연령은 36.6±7.6세였고 남자가 14명(46.7%), 여자가16명(53.3%)이었다. SUMD 점수는 훈련 전 16.9±4.0점에서 훈련 후 12.9±4.2점으로 유의하게 줄어 정신장애에 대한 자기 인식 정도가 향상되었으며(p<0.01), CGI도 훈련전의 3.7±0.9점에서 훈련 후 2.8±0.8점으로 유의하게 호전되었다(p<0.01). 환자의 연령, 발병시 연령, 유병 기간, 입원 기간, 항정신병약물 사용 용량, 교육 정도, CGI로 평가한 임상 상태등은 정신장애의 자기 인식 정도와는 관련성이 없었다. 결론: 정신분열병 입원 환자에서 단축형 증상관리 훈련은 정신장애에 대한 자기 인식을 증가시킬 수 있는 방법이 될 가능성을 확인하였으며 이 방법이 정신분열병 재활치료의 중요한 요소가 될 수 있음을 알 수 있었다. Objectives : The purpose of this study was to examine whether Symptom Management Module-Korean Brief Version(SMM-B) is effective as a psychosocial treatment of the inpat-ients with chronic schizophrenia. We also questioned which of demographic and clinical characteristics could be predictors of differential treatment response. Methods : The subjects were composed of 30 inpatients with chronic schizophrenia, who were trained with weekly session of SMM-B for 5 weeks. Before and after the training, the level of psychopathology, knowledge about schizophrenia were assessed as dependent variables by using Clinical Global Impression(CGI) and Scale to Assess Unawareness of Mental Disorder(SUMD). Results : Overall, patients showed improvement over the treatment period on psychopath-ology as well as knowledge about psychosis. Total scores of SUMD were changed from 16.9±4.0 before training to 12.9±4.2 after training(p<0.01) and scores of CGI were improved from 3.7±0.9 to 2.8±0.8<p<0.01). Howver age, gender, years of education, age of onset, duration of illness, duration of admission, numbers of psychiatric admission, and clinical status evaluated by CGI were not correlated with unawareness of psychosis. Conclusion : These results suggest that SMM-B could be a reliable method to improve self-aw-areness of psychosis in patients whth chronic schizophrenia and one of important elements in rehabilitation.

폐실질내의 주변형 결절로 나타난 소세포성 폐암의 CT 소견

이태희,최요원,전석철,서흥석,함창곡,박충기 한양대학교 의과대학 1998 한양의대 학술지 Vol.18 No.2

We evaluated CT findings of the small cell carninoma, which presented as a solitary pulmonary nodule at the periphery of the lung parenchyma. Of pathologically-proven 45 patients with small cell carcinoma, 10 patients was included in this study, who had a solitary, peripheral lung nodule at distal portion of the subsegmental bronchus. We retrospectively reviewed clinical data and CT findings including size, location, margin, enhancement pattern, lymph node enlargement, metastasis. Peripheral small cell carcinomas were 22.2%(10/45). All masses had well-defined margin and lobulated margin was seen in 7 patients. Mean diameter was 3.8cm (2.5-7.0cm). Enhancement pattern were homogeneous in 3 cases and inhomogeneous in seven. Calcification or air-bronchogram was not present, and focal cavitation was seen in one case. In five, only lung mass was present, and lung mass with lymph node enlargement was seen in one. distant metastasis without lymph node enlargement was noted on two patients and another two patients showed lymph node enlargement and distant metastasis. Peripheral small cell carcinoma is not rare(22.2%). Most frequent CT finding is a well-defined, lobulated mass with inhomogeneous enhancement, these findings would be helpful in differentiating small cell carcinoma from other neuroendocrine tumors when differentiataion is difficult cytologically.

무증상으로 발견된 담낭-담관 누공을 동반한 Mirizzi 증후군 1예

홍진희,전태주,서지영,서동대,오태훈,신원창,최원충,신은아,김기환 인제대학교 2009 仁濟醫學 Vol.30 No.-

Mirizzi's syndrome is a rare complication of the gallstone disease, characterized by narrowing of the common bile duct (CBD) due to chronic extrinsic compression of an impacted gallstone in the cystic duct or the neck of the gallbladder. The impacted gallstone may erode into the bile duct, causing cholecystocholedochal fistula. The patients generally have history of repeated attacks of jaundice and abdominal pain. But there is no report about asymptomatic Mirizzi syndrome with cholecystocholedochal fistula which were found incidentally. So herein we present our clinical experience with a case of asymptomatic Mirizzi syndrome with cholecystocholedochal fistula in a young female.

열공형과 비열공형 피질하 혈관성 치매에서 위험인자의 차이에 관한 비교 연구

배희준,정지향,유경호,나덕렬,김상윤,최경규,양동원,손의주,이상도,김재우,박경원,김응규,이재홍,박미영,한일우,함동석,최문성,하충건,최성혜,이애영,이병철,한설희 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.2

Backgrounds and Objectives: Vascular dementia is a group of dementing disoders arising from various stroke syndrome. Among these. subcortical ischemic vascular dementia (SIVD) is regarded as a relatively distinct clinical entity. However, MRI patterns of SIVD are not homogenous. In some patients, lacunes are dominant, and in others, subcortical white matter changes are. This study was designed to compare risk factor profiles between SIVD with and without multiple lacunes. Methods: We divided 47 subjects (22 males, mean age. 68 years) recruited from VADAPET (Multicenter Trial For Evaluation Of The Changes In the PET Images Of Subcortical Vascular Dementia Patient) study into two groups one with more than 5 lacunes in deep gray matter (lacune group) and the other with 5 or less(non-lacune group) Clinical characteristics and laboratory findings of two groups were compared. Results: Nineteen of 47 patients (40%) belonged to the lacune group. The lacune and non-lacune groups d d not differ in the following variables: age, hypertension, diabetes mellitus, hyperlipidemia heart disease, history of stroke or TIA, history of trauma or major surgery, family history of hypertension stroke, or dementia, age at diagnosis of dementia, body mass index, white blood cell count, ESR, CRP, fibrinogen, hemoglobin A1C, total cholesterol. LDL cholesterol creatinine, proteinuria, glucosuria, and microhematuria. However, male sex, smoking alcohol. hemoglobin, and HDL cholesterol were possibly associated more with lacune group SIVD than with non-lacune group (p<0 1) Multivariate analyses revealed that smoking, hemoglobin, and HDL cholesterol were independent predictors of SIVD with multiple lacunes Conclusion: Our study suggests that SIVD with multiple lacunes may be significantly different in smoking habits hemoglobin, and HDL cholesterol from SIVD without multiple lacunes.