초음파 가이드를 통한 맥락막상강출혈의 치료

이기헌,유재호,김태원,이상준,김신동 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.1

Purpose : Intraoperative suprachoroidal hemorrhage is one of the most serious complications. We report a case of suprachoroidal hemorrhage during phacoemulsification surgery, was managed properly. Methods : Suprachoroidal hemorrhage occurred during phacoemulsificaiton in other hospital. The patient was referred to our department immediately after closing the surgical wound. On initial examination, iris and vitreous were prolapsed through surgical wound. Ciliary body was closely place to anterior chamber, and retina was not visible. Results : Prolapased ocular tissue were reduced by emergency operation. We controlled the patient’s intraocular pressure and inflammation. Ultrasonography was repeatedly performed to check the degree of liquefaction of suprachoroidal hemorrhage. After 9 days of suprachoroidal hemorrhage onset, vitrectomy and drainage through sclera was performed. Postoperative state was stable with successful removal of suprachoroidal hemorrhage. After 2 weeks of secondary operation, retinal detachment has occurred on nasal retinal area, so we performed scleral buckling and endolaser photocoagulation. After 6 months, retina was attached well and intraocular pressure was in normal range. Conclusion : In suprachoroidal hemorrhage, drainage of suprachoroidal hemorrhage after liquefaction of thrombi is effective. After successful drainage, postoperative complications may accompany such as retinal detachment or elevation of intraocular pressure. 목적 : 술중 발생하는 맥락막상 출혈은 매우 심각한 합병증이다. 저자는 수정체 유화술 중에 발생한 맥락막상 출혈을 적절히 대처한 증례를 보고하는 바이다. 대상과 방법 : 수정체 유화술 중 발생한 맥락막상강 출혈환자가 수술창을 봉합 후 즉시 본원으로 전원되었다. 초진시 홍채와 유리체가 수술창을 통해 탈출되어 있었으며, 전방을 통해 모양체가 확인되었으나, 망막은 보이지 않았다. 탈출된 안구내 조직을 응급수술을 통해 복원 후 환자의 안압과 염증을 조절하였다. 초음파를 반복적으로 실시하여 맥락막상 출혈의 액화 정도를 확인하였으며, 출혈 9일 후 유리체 절제술과 공막을 통한 배액술을 시행하였다. 결과 : 맥락막상 출혈이 성공적으로 제거되었으며 술 후 상태는 안정적이었다. 수술 2주 후 비측 망막 박리가 발생하여 공막돌륭술과 안구내 삽관 레이저술을 시행하였다. 6개월 후 망막은 잘 붙어있었으며, 안압은 정상 범위를 유지하였다. 결론 : 맥락막상 출혈의 경우 출혈의 배액 시기를 결정하는 것이 어렵지만, 규칙적인 초음파를 통해 배액술의 시기를 결정할 수 있다. 또한 맥락막상강 출혈의 성공적인 배액 이후에도 망막박리 및 안압상승과 같은 합병증의 동반에 대해 유념해야한다.

콘텍트렌즈 착용전후 측정기기별 굴절력에 관한 연구

성아영,이종헌,박상철,김상균,송경석 대불대학교 2002 論文集 Vol.8 No.1

Heine's Retinoscope is 100% dust proof and incorporates a unique Integrated Polarizing filter which eliminates all internal glare, providing for a clearer, brighter papillary reflex, enhancing performance and ease of examination, As a result of their data basis, we observed and analyzed which instrument has lesser occurring refracting aberration. Contact lens Wearers assuming best visual acuity lead 1.0(20/20) performed over refraction using Retinoscope. Auto Refractor, Auto Refrac-Keratometer and Suresight. The Auto refractor provides highly accurate measurement of patients refraction error. Auto Refrac-Keratometer provides precise and efficient refraction and Keratometry measurements and suggests contact lens base curve values. The automatic calculation of residual astigmatism assists in fitting RGP lenses. Also, suresight is a most convenient instrument for refraction. 30 contact lens wearers are chosen regardless of age, sex, and job. At least 30 minute after placing contact lens in each subjects eye, Performing over refraction by use of Retinoscope, Auto refractor, Auto refrac-Keratometer and suresight. Then presenting each results by graph in consist of spherical part, cylinder, axis, left eye and right eye separately.

방향성 및 동적정보를 이용한 능동적 CNS에 대한 연구

이종헌,김영민,이상준 제주대학교 공과대학 첨단기술연구소 2001 尖端技術硏究所論文集 Vol.12 No.2

The shortest path search algorithm is the most important part in the CNS(Car Navigation System). Most of CNS use dijkstra of A algorithm for searching the path. But those algorithms spend many memory and time to search the path through the real digital map. So we propose an improved algorithm which apply the direction information and the dynamic information such as traffic jams, accidents and terrible weather. The proposed algorithm showed us it can reduce the search area, the number of search nodes and time to calculate. And the simulation system could be able to self-adjust the path immediately, when the dynamic informations reach to the system while the car driving.

시상골 골절단술시 근심골편의 변위를 방지하기위한 lingual fracture technique

장헌수,안재진,우성도,김종필 大韓顎顔面成形再建外科學會 1994 Maxillofacial Plastic Reconstructive Surgery Vol.16 No.1

The sagittal split osteotomy of the mandibular ramus is a common procedure which has been used in the correction of mandibular deformities for a few decades. Although the technical improvements have increased the reliability and stability of SSRO procedure, the postoperative relapse is imperative and clinically more significant than any other complication. One of the major causes of the relapse is due to the displacement of the proximal segment during SSRO procedure, which is well documented in the literature. Therefore it is important to preserve the original position of the proximal segment during SSRO proced and maxillofacial fixation period. In the case of mandibular asymmetry, if one side of mandible is advanced and the other side of mandible is setback during SSRO procedure, the proximal segment in the advancement site will rotate laterally and the proximal segment in the setback site will rotate medially. For the prevention of the lateral rotation or flaring of the proximal segment in the advancment site. we deliberately fracture the posterior protion of the distal segment in green-stick fashion during SSRO procedure, and there is no need to fix the fractured lingual segment. We fix the two octeotomized bony segments in the buccal cortex area rigidly with adjustable monocortical plates and screws. During SSRO procedure the lingual fracture technique was applied to nine patients with severe mandibular asymmetry who underwent orthognathic surgery in our hospital since march, 1992. These clinical experiencies enable us to find the lingual fracture technique has the following advantages. 1. The proximal segment is displaced minimally. 2. The osteotomized bony segments are contacted intimately. 3. The postoperative relapse and the healing period are decreased.

배전 자동화 시스템을 위한 관계 데이타베이스 설계

김상욱,김진호,김광호,이헌길 강원대학교 정보통신연구소 1998 정보통신논문지 Vol.2 No.-

This paper discusses the database design process for the automatic distribution system. Database design is a complex process for specifying the structure of information. In this paper, we first collect and analyze the requriements for the automatic distribution system. Next, we perform conceptual database design reflecting these requirements by using the E-R model. Finally, we perform logical database design reflecting the result of the previous step by using the relational model. Our results would be helpful in developing efficient automatic distribution systems.

방사선 장해에 대한 백작약의 방호효과

오헌,박혜란,정일윤,김성호,조성기 대한방사선 방어학회 2002 방사선방어학회지 Vol.27 No.3

방사선 생체 손상에 대한 방호 효과를 나타내는 천연물을 검색하기 위한 일환으로 한의학에서 보혈양혈 탕제에 널리 사용되는 백작약 (peaonia japonica)을 열수총추출물, 에탄올분획, 조다당분획으로 나누어 방사선에 의한 산환적 손상 경감 효과를 검정하였다. 사람 림프구에서 단세포전기영동 (single-cell gel electrophoresis; comet assay)을 수행하여 DNA 손상 경감정도를 관찰하였으며, 마우스에 백작약 추출물을 투여한 다음 8 Gy의 감마선을 조사한 후 간에서 지질과산화 정도를 살펴보았다. 에탄올분획 처리군에서 높은 DNA 손상 경감효과를 확인할 수 있었으며, 지질과산화 억제작용 및 라디칼 소거효과 또한 에탄올분획이 높은 효과를 나타내어 에탄올분획이 방사선 방호에 주된 역할을 하는 것으로 사료된다. 이상의 결과로 보아 백작약은 방사선의 산화적 손상에 대하여 효과적으로 세포 DNA를 방호하고, 생체막의 주성분인 지질의 과산화를 억제하는 것으로 관찰되어 특히, 독성이 거의 없는 천연물이라는 관점에서 방사선 방호제로 적용이 가능할 것으로 사료된다. We investigated the effect of Paeonia japonica (PJ) on radiation-induced oxidative damage to macromolecules in vitro and in vivo. The PJ reduced the tail moment (TM), which was a marker of DNA strand break in single-cell gel electrophoresis (SCGE; comet assay) in the human peripheral blood lymphocytes. Lipid peroxidation in the liver of the ICR mouse, measured as malondiadehyde (MDA), was also reduced by PJ administration. Ethanol fraction of PJ was more effective than polysaccharide fraction of that on reduction of TM in SCGE and lipid peroxidation. Also, Their activities to scavenge DPPH radicals and hydroxyl radicals were observed in vitro, and the activities were due to its ethanol fraction. It is plausible that scavenging of free radicals by PJ extract may have played an important role in providing the protection against the radiation-induced damage. These results indicated that Paeonia japonica might be a useful radioprotector, especially since it is a relatively nontoxic natural product.

Ferric Sulfate를 이용한 유치의 치수절단술

이상훈,이미나,이상헌 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.4

Pulpotomy is a frequently used treatment modality in primary teeth. It is method by which infected coronal pulp is removed while retaining vital radicular pulp. Since its introduction in 1930 by Sweet formocresol remains the most popular medicament for this treatment. However, despite its outstanding bactericidal properties, formocresol is known to cause adverse tissue reactions. Theoretically, formocresol disinfects and fixes radicular pulp and thus prevents infection and internal resorption. In reality, however,it leads to chronic inflammation and is sometimes responsible for failures through abscess formation and internal root resorption. Also, Myers et al, in 1978, reported on the systemic distribution of FC and other studies have followed with reports of its immunological, mutagenic and carcinogenic effects. Much effort has, therefore, focused on the development of alternative medicaments and techniques. Since its introducion in 19C, ferric sulfate proven itself as an effective hemostatic agent and is used as an astringent in dentistry. In 1988, Landau and Johnsen suggested ferric sulfate be used as a medicament in pulpotomy and many studies have focused on it to overcome the toxic effects of FC, Ferric sulfate acts through its ferric ion and iron ion, which react with blood protein leading to aggregation. The aggregated protein acts to plug the bloodvessels, causing mechanical hemostasis. As blood clot formation is minimal, there is reduced inflammation of radicular pulp and enhanced healing. There are no reports regarding its systemic distribution. This is a report of cases treated by the author using pulpotomy with ferric sulfate.

고속액체크로마토그래피를 이용한 혈장중 로바스타틴산의 분석 : 시료전처리로서 단백침전법 및 고상추출법의 비교 Comparison of Protein Precipitation Method and Solid Phase Extraction Method for Sample Pretreatment

송우헌,장정수,박은우,이상길,최영욱 중앙대학교 약학연구소 1997 약학 논총 Vol.11 No.-

Lovastatin(LV), one of the potent cholesterol-lowering agents, is an inactive lactone prodrug which is metabolized to its active open acid (Lovastatin acid. LVA). In order to optimize the assay procedure of LVA by high performance liquid chromatography(HPLC). solid phase extraction(SPE) method and protein precipitation method were employed for the pretreatment of plasma sample containing LV and LVA, and plasma sample was hydrolyzed under alkaline condition to transform all LV to LVA. Following pretreatment of plasma sample. 100ul of sample was injected onto a reversed-phase C_18 column and eluted with a acetonitrile-pH 3.0 phosphate buffer mixture(45:55 v/v) at a flow rate of 2.0ml/min. Ultraviolet detection was carried out at 238nm. It has been shown that all of LV in plasma was converted to LVA in vitro under alkaline condition. On SPE method, elution with acetonitrile-methanol mixture(75:25 v/v) indicated the highest recovery of LVA, but acid treatment of plasma sample before loading on SPE cartridge revealed little effect on recovery of LVA. Compared with two different pretreatment of plasma sample, SPE indicated better sensitivity and recovery.

대퇴골 간부의 장사상 또는 나선상 골절 치료에 있어 역학적 압박 금속판과 나사고정의 비교

이성태,김동헌,김선남 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

Fractures of the femoral shaft are among the common fractures enconutered in orthpedic practice and resulted from high energy. They bring many associated injury and have severe soft tissue injuries. Today, the interlocking intramedullary nail is regarded as a treatment of choice for fractures of the femoral shaft. But as to long oblique and spiral fractures of femoral shaft, dynamic compression plate and screw fixation are much more used. The department of Orthopedic Surgery, Seoul hospital, Kon-Kuk University Medical center reports about two treatments and the result by comparing between 24 cases who were treated by dynamic compression plates and 20 cases who were treated by screw fixation for long oblique and spiral fractures for femoral shaft from January 1992 to December 1996. The results were as follows: 1. Bony union was finished at average 38.3 weeks, at average 39.5 weeks in cases used dynamic compression plates, at average 37.8 weeks in cases used screw fixation. 2. Complications were 6 cases of joint stiffness of ipsilateral knee joint, 4 cases of nonunion, 2 cases of delayed union, 2 cases of angular deformity, and 1 case of limb shortening. But there was no significant difference between two treatments. 3. Bony union of long oblique and spiral fractures of the femoral shaft that treated by dynamic compression plates and screw fixation was done by so-called primary bone healing. 4. In the treatment of long oblique and spiral fractures of the femoral shaft, screw fixation was no difference in complication but better in bony union than using dynamic compression plate. So it seems to be a good treatment method for long oblique and spiral fractures of the femoral shaft.

Sealed amalgam restoration의 미세누출에 관한 연구

이상헌,이상훈,이재천 大韓小兒齒科學會 2000 大韓小兒齒科學會誌 Vol.27 No.1

아말감은 널리 사용되어 온 대표적 치과재료이지만 치질과의 접착서이 없어 와동의 형태에 의해 유지되는 단점을 가진다. 아말감 수복물은 산화물에 의한 변연봉쇄가 일어나기 전까지 초기에 큰 미세누출을 보이며 수복초기에 이를 적절하게 예방하지 않으면 타액이나 미생물이 와동 내에 침투하게 되고 이로 인해 수복 후의 과민반응, 충전물의 용해 및 파괴, 변연 변색과 2차 우식이 유발되어, 결과적으로 수복물의 수명이 단축되며 치수 병변이 발생될 수도 있다. 최근 기존 아말감 수복의 장점을 그대로 유지하면서 치질삭제를 줄이고 변연을 봉쇄하며 소와열구에 예방적 처치를 함께 할 수 있는 수복법이 제안되었는데 이를 이른바 sealed amalgam이라 한다. 이 술식은 예방적 확대 없이 병소만을 제거한 뒤 수복물 변연과 인접 소와열구에 치면열구전색재를 도포함으로서 소와열구의 예방적 충전은 물론 수복물 변연과 치질사이의 틈을 봉쇄하여 미세누출을 감소시킬 수 있다고 하였다. 이에 저자는 아말감 수복 후 수복물의 마무리 처리와 전색재 적용시점을 달리하여 sealed amalgam 수복과 기존의 아말감 수복과의 미세누출의 차이를 비교하고자 30개의 상, 하악 소구치를 준비하여 Ⅴ급 와동을 소구치의 협, 설측에 형성하고 통상적 아말감 수복을 시행한 후 다음의 각 군으로 나누어 처리하였다. 제 1군 : 24시간 후 연마 (대조군) 제 2군 : 연마하지 않음, 즉시 전색재 적용 제 3군 : 연마하지 않음, 열순환(thermocycling)500회 후 전색재 적용 위의 처리 후 각 군을 5℃와 55℃의 온도변화를 30초씩 번갈아 주며 총 500회의 열순환을 실시한 후 1% methylene blue 용액에 침윤시켜서 100% 습도가 유지된 37℃ 항온기에 24시간 보관하였다. 치아를 레진에 매몰한 후 협설측으로 치아 장축에 평행하게 절단하여 stereomicroscope를 사용해 색소침투도를 관찰하여 다음과 같은 결론을 얻었다. 1. 평균 미세누출은 연마하지 않고 바로 치면열구전색재를 도포한 2군이 가장 낮았고, 연마만 시행한 1군이 가장 높았다. 2. 실험군 간의 미세누출 비교에서 연마만 시행한 1군은 2군에 비해 미세누출이 컸으며 통계적으로 유의성있는 차이를 보였다(p<0.05). 3군은 1군보다 평균 미세누출이 작았으나 통계적으로 유의한 차이가 없었다(p>0.05). 2군은 3군보다 평균 미세누출이 작았으나 통계적으로 유의한 차이가 없었다.(p>0.05) Amalgam, though a widely used dental material, does not bond to the tooth substrate. Therefore, retentive preparation of the cavity is necessary. Such amalgam restorations, until corrosion products form and plug the margin, will show significant marginal leakage. Unless this is prevented early on, saliva and bacteria may enter the cavity, causing postoperative hypersensitivity,dissolution and collapse of the restoration, discoloration of the margin and secondary caries, leading to shortened life-span of the restoration and pulpal pathosis. Recently, a method of restoration has been introduced whereby tooth material can be preserved, cavity margin can be sealed and preventive treatment of pit and fissure can be administered while retaining all the advantages of conventional amaogam restorations. Such sealed amalgams involve removing the carious lesion without extending the cavity for prevention and using pit and fissure sealants to seal cavity margins and pit and fissures to reduce microleakage. In this study, finishing of the amalgam and sealant application were performed after different intervals following of amalgam restoration to compare the microleakage of sealed and conventional amalgam restorations. Thirty bicuspids were prepared with Class V cavity preparations on the buccal and lingual surfaces. After amalgam placement, they were divided into the following groups and treated accordingly. Group 1 : Polishing after 24 hours Group 2 : Immediate sealant application without polishing Group 3 : No polishing, but sealant applied after thermocycling 500 times After treatment, the samples were thermocycled 500 times between 5℃ and 55℃ with a dwell time of 30 seconds. After thermocycling, the snmples were dipped into 1% methylene blue kept in a 37℃ incubator at 100% humidity for 24 hours. The teeth were then embedded in resin and cut bucco-lingually along the tooth axis and observed with a stereomicroscope to determine the degree of microleakage. The following results were obtained: 1. Group 2 showed the least microleakeage, while grorp 1 showed the greatest. 2. Group 1 showed significantly greater microleakage conpared to group 2 (P<0.05). However, no significant differences were found between group 1 and 3 (p>0.05). No significant differences on microleakage were also found between group 2 and 3 (p<0.05).