개화성 백악질-골 이형성증: 증례보고

김남균(Nam-Kyun Kim),김현실(Hyun-Sil Kim),김 진(Jin Kim),남 웅(Woong Nam),차인호(In-Ho Cha),김형준(Hyung-Jun Kim) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.6

Cemento-osseous dysplasia occurs in the tooth bearing areas of the jaws and is probably the most common fibro-osseous manifestation. They are usually classified into three main groups according to their extent and radiographic appearance: periapical (surrounds the periapical region of teeth and are bilateral), focal (single lesion) and florid (scleroticsymmetrical masses) cemental-osseous dysplasias. Florid cemento-osseous dysplasia clearly appears to be a form of bone and cemental dysplasia that is limited to the jaws. Patients do not have laboratory or radiologic evidence of bone disease in other parts of the skeleton. For asymptomatic patients, the best management consists of regular recall examinations with prophylaxis and the reinforcement of good home hygiene care to control periodontal disease and prevent tooth loss. The treatment of symptomatic patients is more difficult. At this stage, there is an inflammatory component caused by the disease and the process is basically a chronic osteomyelitis involving dysplastic bone and cementum. Antibiotics might be suggested, but are not always effective. Two cases of florid cemento-osseous dysplasia diagnosed in two Korean females are reported with a review of the relevant literature.

구강설에 발생한 편평상피세포암의 특성과 치료효과

김기호(Ki-Ho Kim),최은주(Eun-Joo Choi),김형준(Hyung-Jun Kim),남 웅(Woong Nam),차인호(In-Ho Cha) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.1

Introduction: The characteristics of oral tongue squamous cell carcinomas (SCC) and the treatment results were reviewed to determine the appropriate treatment strategies. Materials and Methods: The medical records of 140 patients diagnosed and treated for oral tongue SCC at Yonsei University Health System from January 1995 to December 2004 were reviewed. For statistic analysis, the survival rate was determined using the Kaplan-Meier method with SPSS version 12.0, and the difference in survival rates was evaluated using a log-rank test. Results: The mean age of the patients with oral tongue SCC patients was 55 (19-85 years old). According to the T, N and pathologic stage, the patients were distributed from a higher to a lower incidence of cases, as follows: T2 (46.4%), T1 (37.9%), T4 (8.5%), and T3 (7.1%); N0 (65%), N1 (20.7%), N2 (13.6%), and N3 (0.7%); and stage Ⅰ (31.4%), stage Ⅱ (25.7%), stage Ⅳ (22.2%), and stage Ⅲ (20.7%). Local and regional recurrence and distant metastasis was present in 13.6%, 5% and 4.2% of patients, respectively. The five-year survival rate was 72.2%, and the prognostic factors for oral tongue SCC included neck metastasis, pathologic stage of the disease, cell differentiation, treatment modality, neck dissection as part of the treatment plan, and neck node recurrence. Discussion: It is suggested that ipsilateral neck dissection or bilateral neck dissection should be selected as a treatment of tongue SCC patients with advanced stage.

Lateral override 과두하골절에서 내시경을 이용한 관혈적 정복술 및 내고정의 결과

최은주(Eun-Joo Choi),차인호(In-Ho Cha),남 웅(Woong Nam) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.1

Introduction: Endoscope-assisted open reduction and internal fixation (EAORIF) reduces the amount of facial scaring, but limitations, such as the possibility to convert to the open technique and the large learning curve, remain. Materials and Methods: The medical records of 19 patients diagnosed as lateral overridden subcondyle fractures and treated with endoscopeassisted open reduction and internal fixation at Yonsei University Health System from December 2006 to August 2010 were reviewed. Results: 11 patients underwent temporary discomfort or pain such as limitation of mouth opening, temporomandibular joint discomfort, lip paresthesia or facial weakness, but the symptoms disappeared within 3 months. There was no severe long-term complication except 2 patients with re-fractures of operated subcondyles. Conclusion: Subcondyle fracture with lateral overridden proximal segment is a better indication of endoscope-assisted open reduction and internal fixation than a condylar head/neck fracture, or medial overridden subcondyle fracture: allowing an anatomic reduction.

상악골에 발생한 각화법랑모세포종: 증례보고

원지훈(Ji-Hoon Won),나혜영(Hye-Young Na),김현실(Hyun-sil Kim),김 진(Jin Kim),남 웅(Woong Nam),차인호(In-Ho Cha),김형준(Hyung Jun Kim) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.6

A keratoameloblastoma is a histologically variant of the ameloblastoma group, which varies in size and contains keratin material in the fibrous connective tissue among cystic lesions. A keratoameloblastoma is a rare disease with only 13 cases reported in the literature since Pindborg’s first report in 1970. A 41-year-old man visited, complaining of pus discharged from the right maxilla. He had been diagnosed with an odontogenic keratocyst and was treated with cyst enucleation in the past. The clinical and radiology examination found evidence of recurrence and finally diagnosed him with keratoameloblastoma after enucleation and biopsy. This report discusses the clinical, radiological and histological characteristics of keratoameloblastoma and its treatment. In addition, we report another case of keratoameloblastoma that had transformed from an odontogenic keratocyst.

양극성 장애 조증과 혼재성 삽화의 치료제로서 Topiramate 단독요법의 항조증 효과와 안정성에 대한 예비 연구

천봉희,권성민,장진열,조성남,조 웅,권도훈 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.2

저자들은 양국성 장애 조중삽화 및 혼재성 삽화의 단독 치료제로서 새로운 항경련제인 topiramate의 항조증 효과와 안정성을 평가하기 위하여 본 연구를 하였다. 양극성 장애 조증 삽화와 혼재성 삽화로 진단이되어 입원을 한 환자 14명(남자 6명, 여자 8명)을 대상으로 topiramate를 단독으로 6주간 투여하였다. Young's Manic Rating Scale(YMRS), Brief Psychotic Rating Scale(BPRS)로 환자들의 증상정도를 평가하였으며, 추가해서 체중변화도 측정하였다. 연구결과, YMRS, BPRS 평균점수 및 체중은 topiramate 치료 전에 비해 6주 치료 후에 유의하게 감소되었다. 또, YMRS 점수가 20미만일 때 조증상태가 안정된 것으로 본다면, 본 연구에서 치료 6주 후 YMRS 점수가 20미만인 환자는 14명 중 7명으로 topiramate의 치료 반응률은 50%라 할 수 있다. 가장 흔한 부작용은 위장관 증상으로서 식욕감퇴, 구역, 설사 등이었으며, 이는 6주 연구 후에 topiramate 치료를 중단하게 하는 원인이었다. 진전이나 이상감각은 대체로 topiramate를 투여한 후 1∼2주 내에 나타났다가 1∼2주 지속된 후 사라졌다. 향후 연구에서는 본 연구의 제한점을 보완하는 대조군 연구가 필요하며, 부작용을 줄이기 위한 보다 적절한 topiramate의 증량방법도 고안되어야만 할 것이다. Objectives : Topiramate is a newly developed anticonvulsant agent with possible mood-stabilizing properties. The purpose of this study is to explore the antimanic efficacy and the tolerability of topiramate as monotherapy in bipolarⅠdisorder, most recent episode manic or mixed. Method : In this study, fourteen hospitalozed patients who met the DSM-Ⅳ criteria for bipolarⅠdisorder, most recent episode manic or mixed were given topiramate monotherapy for up to 6 weeks. The response to topiramate was assessed with Young's Manic Rating Scale(YMRS) and Brief Psychotic Rating Scale(BPRS). Body weight changes were also measured. The Ratings were completed at baseline nad then on 1,2,3,4, and 6 weeks. Results : The mean Young's Manic Rating Scale(YMRS) score improved from 38.36(25-42) at baseline to 22.29(12-37) at the end of the study. The Brief Psychotic Rating Scale(BPRS) score improved from baseline mean of 44.64(35-60) to a last observation of 28.92(13-43). The mean body weight decreased from 62.43kg(47-81kg) to 58.64kg(45-81kg). At the end of study, seven patients scored less than 20 on the YMRS score, three of them were less than 13, Adverse events included anorexia(N=9), nausea(N=6), diarrhea(N=4), paresthesia(N=4), tremor(N=2), and rash(N=1). Conclusion : In this study, the response rate to topiramate was 50% as a treatment agent for bipolarⅠdisorder, most recent episode manic or mixed and topiramate might be associated with weight loss. But the adverse effects such as gastrointestinal sympotoms decreased the compliance of topiramate. Inthe future, double-blind controlled studies are needed to further investigate the antimanic efficacy and tolerability of topiramate.

환경미화원의 작업별 근골격계질환 자각증상 특성과 상지의 인간공학적 평가

명준포,이향기,김형렬,정혜선,정은희,남 웅,구정완 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.2

목적: 본 연구는 서울 및 경기 일부 지역의 환경미화원 을 대상으로 신체부위별 근골격계 질환의 증상 호소율을 파악한 후 작업의 차이에 따른 증상호소의 차이를 확인하고,원인 작업을 평가하여 근골격계질환의 관련요인을 찾고자 한다. 방법: 서울 및 경기 일부 지역에 소재하는 환경미화업체 근로자 중 대상자 543명을 대상으로 분석을 시행하였다. 근골격계 질환의 증상호소율은 NIOSH의 근골격계 질환의 자각증상에 대한 기준을 사용하였다. 환경미화원의 작업에 대한 인간공학적인 평가는 RULA. REBA를 사용하여 분석하였다. 결과: 환경미화원의 72.2%가 근골격계질환의 자각증상 및 통증이 있다고 답하였다. 전체 대상자 중에서 상지의 경우 39.6%,허리는 30.0%, 다리는 27.4%가 경도 이상의 통증을 호소하였다. 거리환경미화원의 자각증상 기준별 양성자 비율이 지역환경미화원보다 허리의 '증상 기준 3’를 제외한 모든 영역에서 높게 나타났다. 그리고 거리환경미화원이 상지의‘증상기준 1’,하지의‘증상기준 2∼3’의 영역에서 지역환경미화원보다 통계적으로 유의하게 (p<0.05) 높은 비율을 나타냈다. NIOSH 기준 1∼3에 양성자로 해당하는 군을 종속변수로 작업 이외에 근골격제 질환에 영향을 미칠 것으로 판단되는 인자의 영향을 확인하고자 다변량 로지스틱 회귀분석을 실시하였다. 그 결과 연령이 증가할수록‘증상기준 1’에 대하여 1.018배(95% CI: O.993∼1.046) 근골격계질환의 자각 증상이 증가하였던 것으로 확인되었다. 10시간 이상 작업 할 경우‘증상기준 1’과 ‘증상기준 2’를 모두 만족시키는 경우가 2.165(95% CI: 1.156∼4.1311,2.187배(95% CI: 1.071∼4.65l) 통계적으로 유의하게 높게 나타났다. 지역환경미화원의 RULA,RULA 접수 중 상지의 subtotal A 접수, REBA,REBA 접수 중 상지 total A 점수는 모두 거리환경미화원의 점수에 비해 높게 나타났다. 결론: 거리환경미화원이 지역환경미화원에 비하여 인간 공학적인 평가점수가 낮음에도,거리환경미화원이 상대적으로 높은 반복 작업의 빈도와 10시간 이상 작업 등에 의해 상지에 대한 근골격계 질환의 자각증상 호소한다고 판단된다. 환경미화원의 근골격계질환에 대한 다양한 대책 들이 필요하다. Objectives: The aim of this study was to estimate musculo-skeletal symtoms of municipal sanitation workers and to evaluate working conditions of municipal sanitation workers to search for the factors related to musculo-skeletal symptoms. Methods: We conducted a descriptive cross-sectional survey. The study subjects were comprised of 543 municipal sanitation workers in some divisions of Seoul and the Gyeonggi province. Musculo-skeletal analysis was done by using the modified criteria of NIOSH musuclo-skeletal symptoms, RULA and, REBA. Statistical analysis was done by using the chi-square test, multiple logistic regression analysis. Results: 72.2% of the subjects complained musculo-skeletal symptoms (39.6% on the upperlimbs, 30.0% on the lumbar region, 27.4% on the legs). For the musculo-skeletal symptoms criteria (1∼3), street cleaners complained of more musculo-skeletal symptoms than the solid waste collectors, after classifying the jobs of sanitation workers. On logistic regression analysis of the musculo-skeletal "symptoms criterial" positive groups, age was related to the criteria positive (Prevalence odds ratio=1.018, 95% CI: 0.993-1.046). The worktime was significantly related to 'criteria positive 1 and, 2' (Prevalence odds ratio=2.165 (95% CI: 1.156-4.131), 2.187 times (95% CI: 1.071-4.651)). The RULA score, the subtotal A score of RULA, the REBA score and , the total AREBA score of the upperlimbs of solid waste collectors were higher than those of the street cleaners. Conclusions: In spite of the lower ergonomic evaluation score of the street cleaner, the street cleaners complained of more musculo-skeletal symptoms than did the solid waste collectors due to more frequent repetitive motions, a longer work time (over 10 hours) etc. It is suggested that the sanitation workers need to use the proper methods to avoid musculo-skeletal disease.