사후분해 시체에 대한 법의학적 접근

최영식,이상용,김유훈,조갑래,이봉우,양경무,정낙은,서중석,이한영,이원태,강현욱 大韓法醫學會 2000 대한법의학회지 Vol.24 No.2

Disposal of a homicide victim by dismemberment is rare, but individual cases are on record in most major medicolegal departments. Recognition of postmortem mutilation may be of importance in the interpretation of certain murders committed by sexual perverts and other mentally deranged individuals and sometimes performed for the sole reason of easier disposal of the body. Postmortem dismemberment is usually readily recognizable as such; The edges of the injuries are dry and lack evidence of bleeding. The joints may be disarticulated without fracture, or the use of an axe or saw may be evident from examination of bones. Parallel horizontal or oblique furrows in the bone surface are caused by skipping of the saw prior to establishing depth. Such patterns on the bone may assist in identifying the particular saw involved. So we report 25 dismembered corpses that autopsied in National Institute of Scientific Investigation. This paper can help in attempting to establish not only the first criminal investigation steps but also the medicolegal approach methods in unidentified and dismembered deaths.

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.

기관내 삽관시 Flexiblade 후두경과 Macintosh 형 후두경 사용에 대한 비교

장선영,이상귀,이준례 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.3

Comparison between the Flexiblade Laryngoscope and the Macintosh Blade Laryngoscope in Endortracheal Indubation Sun-Young Jand, M.D., Sang-Kyi Lee, M.D., and Jun-Rae Lee, M.D. Department of Anesthesiology, Chonbuk National University Medical School, Jeonju, Korea Background: The Flexiblade laryngoscope has a unique structure that is composed of a blade and a handle with a trigger. When the trigger of the Flexiblade laryngoscope is squeezed, the hyoepiglottic ligament is depressed, the epiglottis is moved anteriorly, and then the laryngoscopic grade is improved. This study was designed to compare the Flexiblade laryngoscope with the conventional Machintosh blade laryngoscope in the laryngoscopic view in endotracheal intubation. Methods: Following induction of general anesthesia, the laryngoscopic grades of 110 patients were evaluated while five different blade positions of the Flexiblade laryngoscope and a laryngoscopy with the Macintosh blade were performed. The laryngoscopic grades which were described by Cormack and Lehane were classified from 1 to 4. Results: With the Macintosh blade laryngoscope, 98.2% of the patients were grade one and two, and 98.2% of the patients was laryngoscopic grade one and two with partial depression of the trigger of the Flexiblade laryngoscope. The laryngoscopic grade of maximal depression of the Flexiblade trigger had similar results to partial depression of the trigger. However, the partial depression of the Flexiblade laryngoscope showed better laryngoscopic views than the maximal depression of the Flexiblade laryngoscope or the Macintosh blade laryngoscope, respectively. In the overall success rate of endo-tracheal intubation and using the adjusting maneuvers, the Flexiblade laryngoscope was superior to the Macintosh blade laryngoscope. Conclusions: The Flexiblade laryngoscope is comparable to the Macintosh blade laryngoscope for endotracheal intubation, therefore, the Flexiblade laryngoscope can be recommended as the first choice for endotracheal intubation. (Korean J Anesthesiol 2001; 41: 289~296)

당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

Rocuronium의 애별투여방법이 모지내전근의 이완에 미치는 영향

최영균,김승수,이원진,조광래,이상은,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 인제대학교 2009 仁濟醫學 Vol.30 No.-

Objective : There are controversies in pnmmg technique of rocuronium whether it can or can't shorten the onset time. We want to compare the effects of two different priming doses and intervals of rocuronium. Materials and Methods : After giving propofol, 50 patients were randomly assigned to 5 groups. Group I received a placebo, followed 3 min later by rocuronium 0.6 mg/kg. Priming doses and intervals of Group II, Ill, N, V were 0.06 rng/kg and 2 min, 0.12 mg/kg and 2 min, 0.06 rug/kg and 3 min, 0.12 mg/kg and 3 min, respectively. Total dose of rocuronium was 0.6mg/kg. Train of four (TOF) count or ratio and 1st twitch height of TOF (T1) were monitored with 15 secondsintervals. TOF ratio of each groups just before bolus injection, duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were compared. Results : Duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were decreased in priming groups compared to Group 1 (P < 0.01) In group V, significant depression of TOF ratio just before bolus injection was seen (P < 0.05). Conclusion : Priming technique with rocuronium is effective method to shorten the onset of neuromuscular block. But priming dose of rocuronium itself could cause hypoxia and aspiration in awake patients and should be used carefully. Priming dose of rocuronium 0.06 mg/kg and 2 minutes interval maybe relatively safe method.

저칼슘식이와 방사선조사가 백서 악골에 미치는 영향의 실험적 연구

이선기,이상래 大韓口腔顎顔面 放射線學會 1993 Imaging Science in Dentistry Vol.23 No.2

This study was performed to investigate the morphological and structural changes of bone tissues and the effects of irradiation on the mandibular bodies of rats which were fed low calcium diets. In order to carry out this experiment, 160 seven-week old Sprague-Dawley strain rats weighing about 150 gm were selected and equally divided into one normal diet group of 80 rats and one low calcium diet group with the remainder. These groups were then subdivided into two groups., 40 were assigned rats for each subdivided group, exposed to radiation. The group 1 was composed of forty non-irradiated rats with normal diet, Group 2 of forty irradiated rats with normal diet, Group 3 forty non-irradiated rats with low calcium diet, and Group 4 forty irradiated rats with low calcium diet. The two irradiation groups received a single dose of 20 Gy on the jaw area only and irradiated with a cobalt-60 teletherapy unit. The rats with normal and low calcium diet groups were serially terminated by ten on the 3rd, the 7th, the 14th, and the 21st day after irradiation. After termination, both sides of the dead rats mandible were removed and fixed with 10% neutral formalin. The bone density of mandibular body was measured by use of bone mineral densitometer(Model DPX-alpha, Lunar Corp., U.S.A.). Triga Mark Ⅲ nuclear reactor in Korea Atomic Research Institute was used for neutron activation and then calcium contents of mandibular body were measured by using a 4096 multichannel analyzer (EG and G ORTEC 919 MCA, U.S.A.). Also the mandibular body was radiographed with a soft X-ray apparatus(Hitex Co., Ltd., Japan). Thereafter, the obtained microradiograms were observed by a light microscope and were used for the morphometric analysis using a image analyzer(Leco 2001 System, Leco Co., Canada). The morphometric analysis was performed for parameters such as the total area, the bone area, the inner and outer perimeters of the bone. The obtained results were as follows: 1. In the morphometric analysis, total area and outer perimeter of the mandibular bodies of Group 3 were a little smaller than that of Group 1. The mean bone width and bone area were much smaller than that of Group 1 and the inner perimeter of Group 3 was much longer than that of Group 1. The total area and outer perimeter of Group 2 and Group 4 showed little difference. The mean bone width and bone area of Group 4 were smaller than that of Group 2 and the inner perimeter of Group 4 was longer than that of Group 2. 2. The remarkable decreases of the number and thickness of trabeculae and also the resorption of endosteal surface of cortical bone could be seen in the microradiogram of Group 3, Group 4 since the 3rd day of experiment. On the 21st day of experiment, the above findings could be more clearly seen in Group 4 than in Group 3. 3. The bone mineral density of Group 3 was lesser than that of Group 1 and the bone mineral density of Group 4 was lesser than that of Group 2 on the 7th, 14th, 21st days. The irradiation caused the bone mineral density to be decreased regardless of diet. In the case of Groups with low calcium diet, the bone mineral density was much decreased on the 21st day than on the 3rd day of experiment. 4. The calcium content in mandible of Group 3 was smaller than that of Group 1 throughout the experiment. Group 4 showed the least amount of calcium content. The irradiation caused the calcium content to be decreased regardless of diet. In the case of Groups with low calcium diet, the calcium content was much decreased on the 21st day than on the 3rd day of experiment. In conclusion, the present study demonstrated that morphological changs and decrease of bone mass due to resorption of bone by low calcium diet, and that the resorption of bone could be found in the spongeous bone and endosteal surface of cortical bone. So the problem of resorption of bone must be considered when the old and the postmenopausal women are taken radiotherapy because the irradiation seems to be accelerated the resorption of osteoporotic bone.

이하두정방사선사진과 개별화 단층방사선사진을 이용한 하악과두의 형태에 관한 연구

이상래 大韓口腔顎顔面 放射線學會 1994 Imaging Science in Dentistry Vol.24 No.2

The purpose of this study was to observe mandibular condyle shape in an asymptomatic population. In order to carry out this study, 96 temporomandibular joints in 48 adults(22 males, 26 females), who were asymptomatic for temporomandibular disturbances and had no history of prosthodontic or orthodontic treatments, were selected, and radiographed using the Sectograph(Denar Co., U.S.A.) for lateral and frontal individualized corrected TMJ tomograph and submentovertex radiograph. Mandibular condyles were classified morphologically, and measured medioateral and anteroposterior dimensions and condylar angulation. The obtained result were as follows. 1. In the classification of condyle shape on lateral tomographs, 94.8% were convex type and 5.2% were angled type. 2. In the classification of condyle shape on frontal tomographs, 45.3% were convex type, 32.0% were round type, 16.0% were flat type, and 6.7% were angled type. 3. In the classification of condyle shape on submentovertex radiographs, 34.5% were flat-convex type, 22.9% were flat-flat type, 20.8% were concave-convex type, 19.8% were convex-convex type, and 1.0% were concave-flat type and convex-flat type. Concave-concave type, convex-concave type, and flat-concave type were not observed. 4. The average mediolateral legth of the condyle was 19.3mm and the average anteroposterior length was 9.4mm. The average angle between the long axis of condyle and the coronal plane made on submentovertex view was 19.6 degrees.

형질변형성장인자가 손상골 재생능에 미치는 영향에 과한 실험적 연구

이병도,황의환,이상래,홍정표 慶熙大學校 齒科大學 1995 慶熙齒大論文集 Vol.17 No.2

The purpose of this study was to observe the effect of TGF-81, which promotes differentiation and proliferation of osteoblasts, on bone regeneration. Experimental bone defects that measured 3 mm in diameter were created on the mandibles of guinea pig by removal of bone with the use of trephine burs. In one side of mandibular body, the experimental groups, bone defects were grafted with Biogran(Orthovita Co., U.S.A.) and TGF 131(R&D System Co., U.S.A.). In the remaining side of the mandiblar body, the control groups, bone defects were grafted with only Biogran. Guinea pigs in the control and experimental groups were serially terminated by fours on the 3 days, the 1 week, the 2 weeks, the 3 weeks, and the 4 weeks after experiment, and both sides of the mandibular bodies were removed and fixed with 10% neutral formalin. They were decalcified and embedded in paraffin as using the usual method. The specimen sectioned and stained with hematoxylin and eosin. Also, they were radiographed with a soft X-ray apparatus. The Obtained results.=were as follows; 1. Hemorrhagic condition, observed in the granulation tissues, disappeared on the 1 week after experiment in both groups, and more prominent in the experimental group. The granulation tissues of the experimental group had larger number of cells than those of the control group. 2. Osteoblastic differentiation in the margin of grafted material and adjacent bone was observed on the 1 week after experiment in both groups. Also, bone formation was observed in immature form on the 1 week after experiment, and more prominent in the experimental group. 3. In the polarizing microscopic examination, bone matrix was very loose on the 1 week after experiment, but increase in density with time, and more prominent in the experimental group. 4. In the microradiographic examination, newly formed bone was observed in the experimental group on the 2 weeks after experiment, and this was observed earlier than in the control group. Newly formed bone was increased with time and defected area was markedly decreased on the 4 weeks after experiment.

상악동의 실험병소에 관한 X선학적 연구

이주현,황의환,이상래 慶熙大學校 齒科大學 1994 慶熙齒大論文集 Vol.16 No.1

Cell differentiation is a very important process in morphogenesis, and epithelial-mesenchymal interaction may play an important role in cell differentiation. Therefore, during development of root dentin, arcllular cementum and periodontal ligament, the changes of the morphology of dental mesenchymal cells and of the distribution of extracellular matrix proteins - type I collagen, type ID[ collagen, and fibronectin(FN) - are investigated using 14-day-old Sprague-Dawley rats. 1. In the zone of Hertwig's epithelial root sheath, intact epithelial root sheath which is formed with two layers of epithelial a -Rs and covered with basement membranes is observed. Cells of dental follicle and of dental papilla adjacent to the epithelial root sheath are not differentiated yet. In the zone of differentiation, odontoblasts and cementoblasts are differentiated. Cells in the middle of the dental follicle are differentiated into fibroblasts. In the zone of formation, dentin and acellular cementum are observed. The fibroblasts in the forming periodontal ligament are oriented obliquely ard synthesize the collagen fibrils parallel to their direction. 2. In the zone of HERS, immunoreactivity of FN is very strong at the inner basement membrane of the HERS. In this zone, immunoreactivity of type Ill collagen in the extracellular matrix is stronger than in other zones. 3. In the zone of differentiation, cell body of odontoblast shows little of immunoreactivity to FN and collagens. But cell membrane of proximal surfaces of odontoblasts shows very strong immunoreactivity to FN. Along the cementoblasts attached root dentin, strong immunoreactivity to FN is shown. 4. In the zone of formation, acellular cementum matrix is stained strongly to FN. Periodontal ligament shows strong immunoreactivity to FN, type I collagen, and type III collagen with their fibrils' direction. Predentin is stained moderately with FN, type I and type III collagen, but immunoreactivity of mineralized dentin is weaker. 5. Hertwig' s epithelial root sheath ;plays an important role in cell differentiation by the epithelial-mesenchymal interaction. Extracellular matrix of the mesenchymal cells seems to affect the cell differentiation directly and/or indirectly.