Pemphigus vulgaris 환자의 전신 및 구강증상 발현에 관한 증례보고

권병기,안형준,김재홍,최종훈,김종열 대한안면통증∙구강내과학회 2002 Journal of Oral Medicine and Pain Vol.27 No.4

Pemphigus vulgaris is a serious autoimmune disease that forms blisters on mucosa and skin. It is common in people over 60 years of age, and it has a strong genetic tendency. Autoantibodies can be found in intercelluar spaces between epithelial cells, and because of the autoantibodies for desmosomes, desmosomes that connect the squamous epithelial cells are destroyed. In pemphigus vulgaris, oral lesion is almost always present, and it is often present before skin lesions. Oral lesions can be present anywhere in the oral cavity including the mucosa and gingiva. When it is present in the gingiva, it is in a form of desquamative gingivitis. In severe cases, the entire oral mucosa is involved, and various stages of vesicle formation are manifested. In addition, although the treatment of pemphigus vulgaris is relatively successful, the oral lesion is the last to disappear, and periodic deterioration and alleviation of symptoms is common. Definite diagnosis for pemphigus vulgaris is based on microscopic examinations including direct immunofluorescence. As in most autoimmune diseases, immunosuppressive drugs are used for treatment. The prognosis should be made carefully considering its chronic progression and side effects of long-term medications. With early diagnosis and appropriate treatment during the initial stage of pemphigus vulgaris, wide skin involvement can be controlled, and need for aggressive treatment with undesirable side effects can be reduced. In this case report, the continuous treatment of a patient with pemphigus vulgaris was observed in consultation with a dermatologist, and a general investigation of pemphigus vulgaris is made.

치과임상영역에서 발생된 의료분쟁의 판례분석

권병기,안형준,강진규,김종열,최종훈,Kwon, Byung-Ki,Ahn, Hyoung-Joon,Kang, Jin-Kyu,Kim, Chong-Youl,Choi, Jong-Hoon 대한안면통증구강내과학회 2006 Journal of Oral Medicine and Pain Vol.31 No.4

Along with the development of scientific technologies, health care has been growing remarkably, and as the social life quality improves with increasing interest in health, the demand for medical service is rapidly increasing. However, medical accident and medical dispute also are rapidly increasing due to various factors such as, increasing sense of people's right, lack of understanding in the nature of medical practice, over expectation on medical technique, commercialize medical supply system, moral degeneracy and unawareness of medical jurisprudence by doctors, widespread trend of mutual distrust, and lack of systematized device for solution of medical dispute. This study analysed 30 cases of civil suit in the year between 1994 to 2004, which were selected among the medical dispute cases in dental field with the judgement collected from organizations related to dentistry and department of oral medicine, Yonsei university dental hospital. The following results were drawn from the analyses: 1. The distribution of year showed rapid increase of medical dispute after the year 2000. 2. In the types of medical dispute, suit associated with tooth extraction took 36.7% of all. 3. As for the cause of medical dispute, uncomfortable feeling and dissatisfaction with the treatment showed 36.7%, death and permanent damage showed 16.7% each. 4. Winning the suit, compulsory mediation and recommendation for settlement took 60.0% of judgement result for the plaintiff. 5. For the type of medical organization in relation to medical dispute, 60.0% was found to be the private dental clinics, and 30.0% was university dental hospitals. 6. For the level of trial, dispute that progressed above 2 or 3 trials was of 30.0%. 7. For the amount of claim for damage, the claim amounting between 50 million to 100 million won was of 36.7%, and that of more than 100 million won was 13.3%, and in case of the judgement amount, the amount ranging from 10 million to 30 million won was of 40.0%, and that of more than 100 million won was of 6.7%. 8. For the number of dentist involved in the suit, 26.7% was of 2 or more dentists. 9. For the amount of time spent until the judgement, 46.7% took 11 to 20 months, and 36.7% took 21 to 30 months. 10. For medical malpractice, 46.7% was judged to be guilty, and 70% of the cases had undergone medical judgement or verification of the case by specialists during the process of the suit. 11. In the lost cases of doctors(18 cases), 72.2% was due to violence of carefulness in practice and 16.7% was due to missing of explanation to patient. Medical disputes occurring in the field of dentistry are usually of relatively less risky cases. Hence, the importance of explanation to patient is emphasized, and since the levels of patient satisfaction are subjective, improvement of the relationship between the patient and the dentist and recovery of autonomy within the group dentist are essential in addition to the reduction of technical malpractice. Moreover, management measure against the medical dispute should be set up through complement of the current doctors and hospitals medical malpractice insurance which is being conducted irrationally, and establishment of system in which education as well as consultation for medical disputes lead by the group of dental clinicians and academic scholars are accessible.

지정토론 : 주제1_토론1 ; "생명 경시 현상과 부모"에 대한 토론문 -국가의 아동학대 예방 사업-

권병기 열린부모교육학회 2014 열린부모교육학회 정기학술대회 Vol.12 No.-

인공 슬관절 전치환술후 발생한 연부조직 결손에 대해 족배 동맥 피판을 이용한 치료 -1예 보고-

권병기,이송,배은환,서윤형,박훈석,박관영 대한슬관절학회 2004 대한슬관절학회지 Vol.16 No.2

연속공정라인에서 벡터제어용 유도전동기의 오프라인 파라미터 추정

권병기,최창호,현동석 전력전자학회 2000 전력전자학회 논문지 Vol.5 No.1

본 논문에서는 벡터제어용 유도전동기에 대한 파라미터 추정기법을 제시하였다. 이 제어기법은 실제 운전시의 상태와 동일한 조건하에 추정하므로 고성능의 토크제어가 요구되는 연속공정라인과 같은 산업현장에 용이하게 적용할 수 있다. 또한 출력전압의 추정에 의해 전압센서와 측정장치 같은 부가적인 하드웨어가 필요치 않으며, 추정오차에 대한 고정자 전압의 변동을 관찰함으로써 정확하고 매우 안정적인 추정값을 얻는다. 제안된 기법의 타당성 및 유용성은 모의시험장치와 실제 현장라인의 적용을 통하여 입증하였다. In this paper, a parameter estimation method for a vector control of induction motors is presented. It can be easily implemented to the inverters in the industrial fields such as continuous process line, which requires the high performance of torque control, because of being estimated under the condition of the actual operating states. Also, this method nems no additional hardware such as voltage sensors and measuring equipments by the estimation of output voltage, and has good accuracy and repeatability by observing the variation of the stator voltage due to estimation errors. Experimental results verify the validity and usefulness of the proposed estimation method in the industrial fields.

슬관절 전치환술후 발생한 대퇴과상부 골절의 치료

권병기,배대경,정기웅 대한슬관절학회 1997 대한슬관절학회지 Vol.9 No.1

Supracondylar fractures of the femur following total knee arthroplasty are rare complication with reported rates ranging from 0.3% to 2.5%. Union of the fracture in proper alignment, without disruption of prosthetic component fixation and with maintenance of 90 of knee motion, is impotant in treatment of this type of fracture. Modalties of treatment are conservative or operative methods and operative treatment are open reduction 4 internal fixation, intramedullary nailing, revision arthroplasty using a prosthesis with a long stem and closed reduction and external fixation, but there are controversies in the method of treatment. Between Apr. 1989 and Jul. 1994, 10 patients were treated for supracondylar fracture of the ipsilateral femur following total knee arthroplasty and 2 cases of them had arthroplasty at other hospital. Average age of patients was 53 years(29∼68 years), nine patients were women and one was man. The preoperative diagnosis was rheumatoid arthritis in four, degenerative osteoarthritis in three, posttraumatic osteoarthritis in one and tuberculosis sequelae of the knee in two. In nine cases mechanism of injury were slip down and in one was fall down. The interval between arthroplasty and fracture was an average of 22 months(9∼79months). Two cases were treated with closed reduction and cast immobilization, one case was treated with open eduction and internal fixation and seven patients of ten cases were treated with closed intramedullay Ender nailing. The average foIlow-up period after fracture was 25 months(3 ∼ 74months). We evaluated the results as the range of motion, bony union at simple radiograph and Knee Rating Score of Hospital for Special Surgery at last follow up. Eight cases of supracondylar fracture occurred among 350 patients, 514 cases of total knee arthroplasty which were operated at Kyung Hee University Hospital between Apr. 1989 and Jul. 1994 and incidence was 1.6%. At the last follow up, all 10 cases achieved bony union and 7 cases using Ender naiIing achieved clinical bony union which enabled patients to do weight-bearing without pain at postoperative 6∼8 weeks and radiological union was achieved at postoperative 12 weeks. Range of motion were average 105 degrees(80 ∼ 120 degrees) before fracture and 86 degrees(65 ∼ 120 degrees) at the last follow up and HSS Knee rating score were average 80.3 points(59 ∼ 94 points) before fracture and average 78.8 points(66∼89 points) at the last follow up. At 7 cases using Ender nailing, range of motion were average 106 degrees(90 ∼ 115 degrees) hefore fracture and 91 degrees(65∼105 degrees) at last follow up and HSS Knee rating score were average 80.6 points(59∼94 points) before fracture and average 80.3 points(72∼89 poiints) at the last follow up. Closed intramedullary Ender nailing is a recommendable operative method in the treatment of supracondylar fracture following total knee arthroplasty considering to good bony union, satisfactory functional result, easy operative technique and less postoperative complication.

주관절부 골절 후 속발된 내반 변형에 대해 시행한 나사 스타인만 핀을 이용한 외측 폐쇄성 과상부 절골술

권병기,최대정,김진학,이송,김현수,정순영 대한골절학회 2003 대한골절학회지 Vol.16 No.3

목 적: 소아기 주관절 부위 외상 후 속발된 내반 변형에 대해 나사 스타인만 핀과 강선 결박술 고정을 이용한 외측 폐쇄성 과상부 절골술에 대한 임상적 결과를 분석하고 그 유용성을 분석하고자 한다. 대상 및 방법: 1994년 2 월부터 2002년 2 월까지 8년간 본원에서 주관절 내반 변형을 가진 환자에게 외측 폐쇄성 과상부 절골술을 시행하고 나사 스타인만 핀과 강선 결박술을 이용하여 치료한 16예를 대상으로 하였고 남자는 11명 여자는 5명이었고 수술 당시 평균 나이는 21.6세였으며 평균 추시 기간은 19.2개월, 평균 변형각은 내반 21.7도였으며 초기 수상 후 치료시까지의 평균 기간은 16.5년이었다. 결과: 수술 후 교정된 평균 운반각 (carying angle)은 외반 12도였고 술후 고정 기간은 평균 27.8일로 나타났으며, 수술 전 지연 척골 신경 마비 증세를 보이던 1예는 술후 8주에 소실되었고 합병증으로 가벼운 피하 염증이 생긴 2예도 2주 이내 염증이 치료되었으며, Openheim 등의 판정기준에 따라 14예에서 좋은 결과를 얻었다. 결론: 소아 골절 후 생긴 내반주 변형 치료에 폐쇄성 교정 절골술 및 나사 스타인만 핀과 강선 결박술을 이용한 상기 치료 방법은 술후 견고한 고정을 얻을 수 있어 조기 운동이 가능하여 유용한 방법으로 사료된다. 색인단어: 주관절, 내반 변형, 폐쇄성 교정 절골술, 나사 스타인만 핀 370 ※통신저자: 김 진 학 130-011, 서울특별시 동대문구 청량리동 40-12 서울성심병원 정형외과 전화: (02) 966-1616, Fax: (02) 968-2394 e-mail: hapy8845@hitel.net 주관절부 골절 후 속발된 내반 변형에 대해 시행한 나사 스타인만 핀을 이용한 외측 폐쇄성 과상부 절골술 y 371

슬관절 전치환술 후 발생한 대퇴골 골절의 치료

권병기,이송,김경태,김현수,정순영,최대정 대한슬관절학회 2003 대한슬관절학회지 Vol.15 No.1

목적 : 슬관절 전치환술 후 발생한 대퇴골 골절 치료의 결과를 분석하고 수술적 치료 방법 결정에 고려해야 할 요소들에 대해 논하고자 하였다. 대상 및 방법 : 1993년 8월부터 2001년 3월까지 서울성심병원 정형외과에서 슬관절 전치환술을 시행한 환자 중 대퇴골 골절이 발생한 환자 11예를 대상으로 하였다. 치료방법으로는 1예에서만 석고고정을 시행하였고 나머지 10예에서는 수술적 치료를 시행하였다. t술적 치료에 시행한 예에서는 골절위치, 전이 및 분쇄정도와 환자의 내과적 무제 및 전신상태를 고려하여 내 고정물을 선택하였다. 이들 11예를 대상으로 골절 전과 최종 추시시의 방사선 소견상 경골-대퇴각, 관절 운동 범위 및 Hospital for Special Surgery (HSS)의 점수를 비교 분석하였다. 결과 : 대퇴골 골절의 발생 빈도는 총764명, 1133슬관절 중 11예에서 인공 삽입물 주위의 대퇴골 골절이 발생하여 0.9%의 발생빈도를 보였다. 수술적 치료를 한 10예 중 간부까지 골절되면서 전위가 심하지만 골다공증이 없고 전신상태가 양호한 4예에 대해서는 역동성 금속판 및 나사못 고정술을 시행하였고, 골절이 과상부 부위에 위치하고 분쇄가 심하며 고령이면서 내과적으로 심, 폐부전을 동반한 3예에 대해서는 Ender정 삽입술을 시행하였으며, 2예에 대해서는 골절부 분쇄와 전이가 심하지 않았기 때문에 역행적 교합성 골수강내 정삽입술을 시행하였다. 골경과 심, 폐부전을 동반한 약간의 전위와 비분쇄 골절인 1예에서는 도수정복에 실패하여 관혈적 정복 후 1개의 해면 나사못 고정술을 시행하였다. 평균 추시 기간은 19개월이었고 방사선 소견상 경골-대퇴각은 골절전 평균 외반 6.2도였고 최종 추시시 외반 8.2도였으며, 관절 운동 범위는 골절 전 평균 109도, 최종 추시시 98도였으며 HSS 점수는 골절 전 평균 84점, 최종 추시시 78점이었다. 결론 : 슬관절 전치환술 후 발생한 대퇴골 골절의 치료에 있어서 좋은 결과를 얻기 위해서는 골절의 형태에 따른 치료 방법과 수술시 내 고정물의 선택이 적절하여야 하며, 환자의 내과적 문제 및 전신 상태도 충분히 고려되어야 할 것으로 사료된다. Purpose: To analyse the results of the treatment of femoral fractures following total knee arthroplasty(TKA) and to discuss about factors determining operative methods. Methods & Materials : Between August 1993 and March 2001, 11 knees in 11 patients were treated for femoral fracture following TKA in Seoul Sacred Heart General Hospital. Only one case was treated with cast immobilization and ten cases were treated with operative method. In operative cases, before choosing the fixation devices, we considered the location, displacement and comminution of fractures and general conditions of patients. We analyzed clinical results according to the tibiofemoral angle, range of motion(ROM), and the knee rating score of Hospital for Special Surgery (HSS). Results : Among 1133 knees in 764 patients with primary TKA, eleven cases underent femoral fractures following TKA. The includence was 0.9%. Among ten cases which were treated operatively, four cases had severe displacement without osteoprosis and were treated with dynamic compression plate (DCP) and screws. Thress cases had displaced comminuted fractures with ostoprosis and medical problems, so they were treated with Ender nailing. Two cases had mild displacement and comminuted and were treated with retrograde interlocking IM nailing. One case was with uncomminuted fracture with cardiopulmonary insufficiency and old age. Because initial closed reduction was failed, open reduction was performed and cancellous screw fixation was done. The average follow up period after fracture was 19 months. Radiologically, tibiofemoral angle was valgus 6.2 degrees on an average before fracture and valgus 8.2 degrees at the last follow up. ROM was 109 degrees on an average before fracture and 98 degrees at the last follow up and HSS knee rating score averaged 84 points before fracture and 78 points at the last follow up. Conclusion : Selection of treatment methods and fixation devices accordign to fracture type was important for satisfactory functional results, patient's general conditions and medical problems must be considered.

전기로용 다단 H-브릿지 STATCOM의 전류제어

권병기(Byung-Ki Kwon),정승기(Seung-Ki Jung),김태형(Tae-Hyeong Kim),김윤현(Yun-Hyun Kim) 전력전자학회 2015 전력전자학회 논문지 Vol.20 No.1

A static synchronous compensator (STATCOM) applied to rapidly changing, highly unbalanced loads such as electric arc furnaces (EAFs), requires both positive-sequence and negative-sequence current control, which indicates fast response characteristics and can be controlled independently. Furthermore, a delta-connected STATCOM with cascaded H-bridge configuration accompanying multiple separate DC-sides, should have high performance zero-sequence current control to suppress a phase-to-phase imbalance in DC-side voltages when compensating for unbalanced load. In this paper, actual EAF data is analyzed to reflect on the design of current controllers and a pioneering zero-sequence current controller with a superb transient performance is devised, which generates an imaginary -axis component from the presumed response of forwarded reference. Via simulation and experiments, the performance of the positive, negative, and zero-sequence current control of a cascaded H-bridge STATCOM for EAF is verified.

산업현장에서 벡터제어용 유도전동기의 오프라인 파라미터 추정

권병기(Byung-Ki Kwon),박가우(Ga-Woo Park),신원창(Won-Chang Shin),조응상(Eung-Sang Cho),이진섭(Jin-Seop Lee),최창호(Chang-Ho Choi) 전력전자학회 1998 전력전자학술대회 논문집 Vol.- No.-

Parameter estimation of induction motor for vector control presented in this paper can be easily implemented and applied to inverters in the industrial field, because it needs no additional hardware such as voltage sensor and measuring equipment. At first, the stator resistance including switching loss of inverter is measured by simple voltage-current equation. Next, in pre-magnetization of machine by imposing the d-axis constant field-current, q-axis torque current is forced to the machine until its speed feedback reachs to pre-defined level of speed limit. At this time, we can measure the rotor time-constant by decreasing the distorted output-voltage inverter. At last, stator inductance, transient inductance, and moment of inertia can be measured by the relationship of output voltage, output torque and speed feedback. The validity and usefulness of this method is verified by experimental results.<br/> <br/>