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채종균,송지수,신터전,현홍근,김정욱,장기택,이상훈,김영재 대한소아치과학회 2020 大韓小兒齒科學會誌 Vol.47 No.1
The number of pediatric dental clinics has been increasing due to the development of dentistry and changes in public awareness of professional dental care for children. The purpose of this study was to investigate the present status of pediatric dental clinics in Korea in several respects, including regional distribution. There were 343 pediatric dental clinics (1.91%) among 17,917 dental clinics in Korea. 248 out of 343 private practitioners were board certified pediatric dentists. Of 248 board certified pediatric dentists, 25 displayed the specialty in their clinics’ name. Gyeonggi occupied largest share of the total pediatric dental clinics in Korea, followed by Seoul and Busan. Gangnam-gu occupied largest share of the total pediatric dental clinics in Seoul. Out of all pediatric dental clinics in Korea, 78.7% was run by only one dentist. 90.9% of pediatric dental clinics didn’t do night clinic on weekdays and 26.5% was open until after 15:00 on Saturday. 1956년 한국에 처음 소아치과학교실이 창설되었고, 1992년 한국 최초의 소아전문 치과의원이 등장하였다. 치의학의 발전과 소아치과에 대한 대중의 인식 변화로 인해 소아전문 치과의원은 점점 더 증가하고 있다. 이 연구의 목적은 지역 분포를 포함한 여러 측면에서 한국의 소아전문 치과의원의 현황을 조사하는 것이다. 한국에 17,917개의 치과의원 중 소아전문 치과의원은 343개이고, 1.91%를 차지하였다. 343명의 소아전문 치과의원 개원의 중 248 명이 소아치과 전문의였다. 소아치과 전문의 248명 중 25명이 전문의를 표방하여 개원하고 있었다. 16개의 시도 중 경기도에 소아전문 치과의원이 가장 많았고, 33.5%를 차지하였다. 서울과 부산이 그 뒤를 이었다. 서울의 25개 구 중에서는 강남구에 소아전문 치과의원이 가장 많았고, 유소년 10만명당 소아전문 치과의원 수도 강남구에서 제일 높았다. 소아전문 치과의원의 90.9%는 평일 야간진료를하지 않았고, 26.5%는 토요일에 15시 이후에 문을 닫았다.
근이영양증(muscular dystrophy) 환자의 전신마취 하 치과치료 : 증례보고
채종균(Jong Kyun Chae),송지수(Ji-Soo Song),신터전(Teo Jeon Shin),현홍근(Hong-Keun Hyun),김정욱(Jung-Wook Kim),장기택(Ki-Taeg Jang),이상훈(Sang-Hoon Lee),김영재(Young-Jae Kim) Asia association of Disability and Oral health 2019 International Journal of Disability and Oral Healt Vol.15 No.1
본 증례는 다수의 치아우식증을 주소로 내원한 근이영양증 환자의 전신마취 하 치과치료에 대한 보고이다. 근이영양증 환자들은 진행성 근육 약화로 인해 구강위생 관리하기가 힘들고 치아우식이 호발할 수 있다. 따라서 정기적으로 치과를 내원하고 올바른 구강 위생 습관을 확립할 수 있도록 환자 및 보호자교육을 실시하여야 한다. 치과치료 시에는 흡인으로 인한 호흡기 합병증이 발생하지 않도록 액체의 흡입을 주의 깊게 하여야 한다. 비협조적이거나 매우 어린 근이영양증 환자에서는 전신마취가 필요할 수 있다. 전신마취 시에는 악성 고열증의 위험 때문에 휘발성 마취제를 피해야 한다. Muscular dystrophy (MD) is a heterogeneous group of inherited neuromuscular disorders, characterized by progressive muscle weakness. Severity of the disease ranges from mild to severe, and the disease is mostly caused by mutations in a number of genes. These genetic mutations cause lack of proteins which are essential for muscle cell stability. Muscle fibers are gradually replaced by fat and fibrous tissue. The muscles of the head and neck are affected in several types of MD that manifest as altered craniofacial morphology and dental malocclusion. A 3-year-10-month old, 15.0 kg boy with MD presented to Seoul National University Dental Hospital, Seoul, South Korea because of extensive carious teeth. A number of dental caries in primary dentition were identified during clinical oral examination. Due to dental anxiety and underlying systemic disease, general anesthesia was considered. General anesthesia was induced and maintained with intravenous anesthetics, propofol and remifentanil. Caries treatments - resin restoration, pulpectomy, zirconia crown restoration, stainless steel crown restoration - were performed. Under general anesthesia, successful dental procedure was done. Total intravenous anesthesia (TIVA) was performed instead of inhalation anesthesia in order to avoid risk of complications such as malignant hyperthermia and life-threatening rhabdomyolysis. With decreasing muscle function, plaque control becomes more difficult and leads to gingivitis. Especially, the open-mouth posture worsens gingivitis and can leads to malocclusions and problems in swallowing. Regular and periodic dental care is essential for maintaining oral health for patients with MD.
모야모야병(moyamoya disease) 환자의 전신마취 하 치과치료: 증례보고
채종균(Jong Kyun Chae),송지수(Ji-Soo Song),신터전(Teo Jeon Shin),현홍근(Hong-Keun Hyun),김정욱(Jung-Wook Kim),장기택(Ki-Taeg Jang),이상훈(Sang-Hoon Lee),김영재(Young-Jae Kim) Asia association of Disability and Oral health 2019 International Journal of Disability and Oral Healt Vol.15 No.1
본 증례는 다수의 치아우식증을 주소로 내원한 모야모야병 환자의 전신마취 하 치과치료에 대한 보고이다. 모야모야병은 치과치료 동안 상당히 주의를 필요로 하는 다양한 전신질환과 관련이 있다. 여러 과의 의사들과 협진이 필요하고, 치과 예방치료에 초점을 맞추면서 적절한 시기에 치료하는 것이 중요하다. 모야모야 환자에서 울음과 과호흡은 저칼륨혈증을 일으킬 수 있고, 대뇌 혈관 수축 효과를 일으킬 수 있다. 치과치료 시뇌졸중 발생을 예방하기 위해서 통증과 불안을 조절하는 것이 매우 중요하다. 비협조적이거나 매우 어린 모야모야병 환자에게 치과치료를 하기 위해서는 전신마취가 필요할 수 있다. Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease of unknown etiology characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. The clinical presentations of MMD include transient ischemic attacks (TIA), ischemic stroke, hemorrhagic stroke, seizures, headache, and cognitive impairment. MMD is the most important cause of stroke or TIA in children in East Asian countries. A 5-year-3-month old boy with MMD experienced cerebral infarctions five times. Cerebrovascular anastomosis surgery was performed on him four years ago. He had dysphagia, developmental delay, hemiplegia, and strabismus. Besides, a number of dental caries in primary dentition were identified during clinical oral examination. Dental treatment under general anesthesia using sevoflurane was performed due to his lack of cooperation and underlying systemic disease. MMD is associated with various medical diseases requiring thoughtful consideration during dental treatment. Crying and hyperventilation in MMD patients may cause hypocapnia and have a cerebral vasoconstrictive effect. If dental treatment is required, control of pain and anxiety is very important. General anesthesia may be considered for dental treatment in uncooperative or very young patients with MMD.
방병기,윤영석,이정상,한대석,이호영,김형규,박한철,강종명,김명재,이희발,류석희,윤견일,고행일,오하영,유병희,정영,정석호,나하연,이시래,김기현,원대식,전건웅,조동규,윤경우,김현철,최일균,강영준,채종구,임중규,구완서,최의진,김문재,전성주,송정균,이광훈,성낙억,최영주,최창필,강성귀,나영호,김문중,신영태,김석영,이영규,남궁견 대한신장학회 1988 Kidney Research and Clinical Practice Vol.7 No.2
Since 1981, the Korean Society of Nephrology started annual report on renal replacement therapy in Korea. The annual number of new patients receiving dialysis treatment in 1986, compared with 1985, rose from 825 patients (20.4 per million population) to 957 patitents (23. 3 per million population) and the total number of patients on replacement therapy rose from 1,508 patients (37.3 per million population) to 2,534 patients (61.7 per million population). 1,335 patients (32.6 per million population) of these patients were living on hemodialysis, 573 patients (13.9 per million population) on continuous ambulatory peritoneal dialysis (CAPD) and 621 patients (15.1 per million population) on fun- ctioning renal graft as of December 31, 1986 The common causes of renal failure of new patients were chronic glomerulonephritis (41,6%), followed by diabetic nephropathy (12.6%), hypertensive nephroscler- osis (7.8%), chronic pyelonephritis (2.5%) and others. The annual mortality rate fell from 21.9% in 1981 to 13. 5% in 1986. The common causes of death in patients on dialysis therapy in order were cardiac (32.8%), vascular (14.7%), infective (14.7%) social problems (11.2%). Recently, the number of patients requiring dialysis is rapidly increasing due to expanded medical insurance support for dialysis and improved economic status of our country. Therefore, it is necessary to draw up counterplan for a rapid growth of the number of new patients.